A woman has died and 22 people have been injured in a crash involving a double-decker bus and two cars.
Fire crews helped to free the bus driver and three people from one of the cars after the crash on the A3054 near Newport, Isle of Wight.
Four of the casualties were airlifted to hospital after the collision, at 12:45 BST.
St Mary’s Hospital in Newport declared a major incident and called in extra staff to deal with the casualties.
The dead woman, in her 60s, was travelling in a Fiat Bravo, police said.
Three other people who were in the vehicle with her are in a serious condition in hospital.
A spokeswoman for Isle of Wight NHS Trust said: “A major incident was declared at 13:51 today after a serious road traffic incident took place on Forest Road, Newport, involving two cars and a bus.
“The Isle of Wight NHS Trust can confirm that four people have been airlifted to mainland hospitals and currently 15 patients have been brought into St Mary’s Hospital.”
In a statement, Hampshire Police added: “The driver of the bus, a man in his 50s, is also said to have sustained a serious injury.
“Ten passengers who were travelling on the bus have also been taken to hospital as a precaution.
“Four people travelling in a silver Mini Cooper, were also taken to hospital as a precaution.”
Four air ambulances from different regions attended the scene, taking casualties to hospitals in Southampton and Brighton.
St Mary’s Hospital had asked people not to attend the emergency department but later stood down its major incident status.
Hampshire Fire and Rescue Service, which deploys the island’s fire appliances, sent five crews to the scene.
A spokeswoman said: “We extricated three people from one car as well as the bus driver.”
Richard Tyldsley, general manager of Southern Vectis, which operates the bus, said: “At this stage the full circumstances of the incident are unclear, but sadly I understand one of the cars’ occupants has died.
“This is very distressing for all concerned and I would like to pass our sincere condolences to their family and friends.
“The extent of any further injuries is currently unclear. We know several people have been taken to hospital and our driver had to be cut from his cab.”
The firm added it was assisting the police with their inquiries, as well as carrying out its own investigation.
Some bus services would not be operating as a result of the crash, Southern Vectis added.
Road closures have been put in place around the area and are expected to remain for some time.