On 101405 at 2317 hrs Station 4 4 along with Rescue 4 2 Gap Ambulance 4 3 1 Gordonville Ambulance 4 9 White Horse and Medic 9 Ephrata Hospital were alerted to a vehicle accident w entrapment involving a tractor trailer at the intersection of New Holland Road and Old Philadelphia Pike. Deputy 4 4 arrived reporting a vehicle head on into a tractor trailer w 2 patients trapped w one unresponsive. A request was made for an one additional ALS alerting Medic 6-12-8 LEMSA The Rescue crew quickly popped the drivers side door which allowed personnel to access to the two seriously injured victims. Itnbsp appeared the pickup truck first struck a horse that was running loose in the east bound lane of Rt. 340 and went out of control before crossing over into the westbound lane crashing head on into a milk tanker that had stopped when the driver noticed the runaway horse. The horse was killed instantly. The patients were transported by ambulance to a Lancaster Hospital. Units went available at 0125 hrs.