Two people have died and six others have been injured in a two-car crash on a dual carriageway.
West Midlands Ambulance Service said two women in the front of one of the vehicles were confirmed dead at the scene of the accident on the A38 near Burton-upon-Trent in Staffordshire on Friday.
Four ambulances, a rapid response vehicle, a paramedic officer and two air ambulances were sent to treat those injured in the accident, which was reported to the emergency services at about 7.45pm.
A West Midlands Ambulance Service spokesman said both cars had suffered extensive damage.
The spokesman said: "Unfortunately, it quickly became apparent that nothing could be done to save two women travelling in the front of one car, and both were confirmed dead at the scene."
Three rear seat passengers - two boys aged 14 and 17 and a 12-year-old girl - travelling in the same car suffered serious injuries and were taken to hospitals in Coventry, Stoke-on-Trent and Burton.
The spokesman added: "In the second car, a man believed to be in his 30s suffered leg and back injuries. Following emergency treatment he was airlifted to University Hospital North Staffordshire."
A woman believed to be aged in her 20s suffered multiple serious injuries and was transferred by land ambulance to hospital in Burton for further emergency treatment, while a four-year-old girl suffered abdominal and pelvic injuries and was admitted to Birmingham Children's Hospital.