One person died and another remains hospitalized with serious injuries after a high-speed crash on the afternoon of February 1 in an unlikely place: Hill Street in Southampton Village, where the speed limit is 25 mph.

But witnesses estimated that a driver was going three times that speed—one said it was “like he was on a racetrack”—passing vehicles in the oncoming lane while heading west at 3:19 p.m. last Wednesday. His SUV slammed nearly head-on into another SUV with such force that the struck vehicle’s driver spun into a tree and was thrown 25 to 30 yards from the vehicle, coming to rest on a nearby lawn.

She survived with serious injuries, but her passenger, a young au pair from Germany who had just arrived in the United States, was pronounced dead on Monday from injuries suffered in the crash.

Southampton Village Police Detective Sergeant Herman Lamison said the speeding driver of the 2008 Lexus R35, Jacob A. Alegria, 27, of Southampton was injured as well, but he was discharged from the hospital on Friday.

According to Det. Sgt. Lamison, no charges have been filed, as police are waiting for a toxicology report and a full reconstruction of the accident. He would not yet say what charges might be filed.

Mr. Alegria’s attorney has suggested that a medical condition might have played a role in the incident, and at least one witness said the driver said after the crash that he had been “confused.”

Police said Mr. Alegria’s vehicle left the westbound lane of Hill Street and struck an eastbound 2015 Audi Q5 driven by Luisa “Lulu” S. Keszler, 26, of Southampton.

Police said her passenger, Charlotte Meyer, 20, was removed from the vehicle, and medical personnel—including a physician who stopped to render aid—stabilized her. Both Ms. Meyer and Ms. Keszler were airlifted directly to Stony Brook University Hospital. Mr. Alegria was transported to Southampton Hospital by Southampton Volunteer Ambulance, then subsequently sent to Stony Brook as well.

According to a spokeswoman for Stony Brook University Hospital, Ms. Keszler was originally listed in critical condition, but her condition had been upgraded to serious as of Monday.

The hospital confirmed on Tuesday that Ms. Meyer had died of her injuries on Monday night.

Ms. Meyer had arrived in the U.S. to work as an au pair for Ms. Keszler’s 9-month-old daughter just days before the accident. Corey Ziolkowski of Karratha in Western Australia, who knew Ms. Meyer, said in a Facebook chat on Monday that “Charly” was kind and funny. He had met her in Karratha after she moved there with Mr. Ziolkowski’s girlfriend from Germany, to work as an au pair.

Roughly 10 months ago, Mr. Ziolkowski said, Ms. Meyer moved back to Germany and saved up money for her trip to the United States. She left for the States on January 24 and told Facebook friends she would be in Southampton.

“My girlfriend is devastated,” Mr. Ziolkowski said by Facebook chat this week.

Emily Tyson of Hampton Bays, an eyewitness to the crash, described Mr. Alegria as driving “like he was on a racetrack.”

A teacher in the Sag Harbor School District, Ms. Tyson rarely takes Hill Street on her way home, but had been traveling westbound on that road after stopping at the UPS Store, just east of where the accident took place. Ms. Tyson said Mr. Alegria swerved into the oncoming lane to pass her just before the crash—nearly hitting a car headed east.

“The move itself made me question what the heck was going on,” she said on Thursday, the day after the crash. “He swerved back in front of me just in time to avoid that other car.”

Then he “floored it,” she said—so fast that the Lexus SUV quickly disappeared from view around the bend on Hill Street.

“It all happened so, so fast,” she said in a phone interview Thursday morning, her voice quivering. “But I saw him collide with the black car—because it happened right in front of me. I saw the person get ejected from the car.”

Kerri Cunningham Pace of East Quogue also witnessed the crash, and she confirmed the version of events provided by Ms. Tyson.

Ms. Pace, who is the production manager for the Press News Group, was driving behind Mr. Alegria. She said she watched him “speed up and pass” Ms. Tyson’s vehicle, moving into the oncoming lane to do so, and nearly hitting an eastbound vehicle in the process. She said he then sped away on Hill Street.

The next thing Ms. Pace saw was smoke from the crash scene ahead.

A lifeguard for 16 years, with basic first aid and CPR training, Ms. Tyson quickly ran to Ms. Keszler, who was lying on the grass near the accident scene, where she had been thrown. Ms. Tyson said she wanted to offer what help she could, but found her so badly injured that she simply stayed with her and told her help was coming. Ms. Keszler did appear to regain consciousness at one point and even tried to sit up, she said.

Ms. Pace stopped to help Ms. Tyson render aid and, spotting an infant’s car seat in the back of the struck vehicle, began to search for a baby in the wreckage. Ms. Pace said she was relieved to find that there was no child in the car.

Ms. Tyson said police were first to arrive, and that EMTs were on the scene within three minutes. Before then, Dr. Babak Maharlouei, an anesthesiologist in Southampton who happened to be passing by, stopped to help Ms. Meyer, who had been pulled out of the car by police. Calls to Dr. Maharlouei were not immediately returned this week.

Ms. Tyson said Mr. Alegria, had gotten out of his vehicle after the crash and walked over to where she was, near the woman lying in the front yard. She noticed that his knuckles were bloody but did not observe any other injuries. “They just looked like abrasions,” she said. “But he was walking, totally conscious.”

She also said, and Ms. Pace agreed, that Mr. Alegria did not appear to be intoxicated in any way. “He seemed scared,” Ms. Tyson said, adding that he was very emotional. “I think because he realized what he did.”

Ms. Tyson recalled talking with him: “I just looked up at him and said, ‘What were you thinking? You almost killed me—and you might have killed these people.’”

She said his reply was: “I don’t know. I was confused.”

Mr. Alegria never tried to leave the scene and appeared to cooperate with police, Ms. Tyson said.

“[Jacob Alegria] was already very upset and emotionally strained knowing that Lulu and her friend were hurt,” said Colin Astarita, the Southampton-based attorney representing Mr. Alegria, in a prepared statement on Tuesday. “At the time of the accident, he was unaware of who was in the car, but Jacob is actually a friend of Ms. Keszler—which only deepens how sorry he is that this happened.”

On Friday, Ms. Keszler’s father, Stephan Keszler, posted on Facebook that his daughter had spent the night at the intensive care unit and said that it was “good news” that she was in good hands. On Saturday he posted, “We are grateful … please continue to pray for Lulu, Charlotte and the many people in need.”

Multiple attempts to reach Mr. Keszler for comment about his daughter’s condition were not returned.

Many people who know Ms. Keszler, who works as a real estate broker for Douglas Elliman in Bridgehampton, have written messages of support on Facebook following the accident.

Paul Brennan, the executive manager of sales at Douglas Elliman in Bridgehampton, said on Thursday, February 2, that everyone there is concerned for Ms. Keszler’s health and well-being, and that they wish her a “speedy recovery.” He also said they are ready to offer support to her family in the days ahead.

“We are awaiting the results of accident reconstruction and the police investigation regarding the cause of the accident,” Mr. Astarita, Mr. Alegria’s attorney, said. “There has been some talk of Mr. Alegria’s physical condition and whether or not he suffers from vertigo or some type of seizures, but I cannot confirm anything until we have the results of a medical evaluation to determine whether there was a contributing factor to the accident.

“At this time, I know that Mr. Alegria wanted to convey how sorry he is and that he and his family’s thoughts and prayers are with the Keszler and Meyer families,” he added.

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