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A school bus was blocks away from its first stop Tuesday morning when it hit a cemetery wall, rear-ended a car and then ricocheted off a roadside pillar into an oncoming commuter bus. The pre-dawn accident killed six people and injured 10, authorities said.

There were virtually no skid marks at the crash scene, suggesting no braking by the 67-year-old school bus driver, who was killed, and leading to what Baltimore police spokesman T.J. Smith called a working theory that he had suffered some sort of medical emergency.

The 33-year-old female driver of the Maryland Transit Administration bus also died at the scene, along with four of her 12 passengers, Smith said.

“This was a grueling and gruesome process of removing bodies,” he said.

The only other occupant of the school bus, an aide, suffered minor injuries, Smith said. The car driver also survived with minor injuries. All eight of the surviving commuter bus riders were hurt, two of them critically, he said.

All the victims were adults. Police have not yet released any of their names, pending notification of relatives.

Smith said an autopsy will help determine whether the school bus driver had any medical conditions that could have contributed to the crash.

He said investigators have recovered recording equipment from one of the buses that he believes contains video and possibly data evidence — if it can be retrieved.

“We have to see the viability of it after this catastrophic accident,” Smith said.

National Transportation Safety Board investigator Jennifer Morrison said her team has begun looking at the vehicles and crash scene. She said they will likely remain in Baltimore through the week, gathering facts to determine the cause of the crash and make safety recommendations.

Baltimore Police Commissioner Kevin Davis said riders on the No. 10 MTA bus were likely going to work on a route from Dundalk, a largely blue-collar community southeast of Baltimore, toward Catonsville, a western suburb.

“They’re on their way to make a living, they’re on their way to the job, and they’re on their way to support their families,” Davis said, “Our hearts and prayers go out to them, to their families, to their co-workers as well.”

The school bus first hit the cemetery wall, then struck a silver Ford Mustang, crushing its rear and forcing its nose into the pavement. Then it hit a pillar at the cemetery entrance hundreds of feet down the street. Veering across the double-yellow center line, the yellow school bus slammed into the front driver side of the MTA bus, ending about 100 yards from the pillar.

The school bus raked the side of the commuter bus, finally stopping with its front end buried in the left rear quarter of the MTA vehicle on Frederick Avenue near Loudon Park Cemetery.

The Mustang driver, Shawn Braxton, said he was driving to work when the bus hit his car. Bystanders helped him get out, he said.

Braxton said he was bruised but also struggling emotionally.

“I’m just mentally trying to deal with, you know, surviving the accident while other people died,” he told The Associated Press.

The school bus was contracted from Baltimore-based AA Affordable Transportation and served 18 elementary students, the city’s public school system said in a statement.

Federal records show the company had no violations or other crashes reported in the two years ending this past September. In 2012, an AA Affordable school bus was involved in a crash that injured at least 13 people, including students, when it collided with a minivan, the Baltimore Sun reported.

The company’s five-year contract with the school district ends in June 2018, according to online public records.

One of the company’s drivers, Chernell Burrows, told reporters that the late driver was kind and dependable.

“I’m so sad,” Burrows said.

Some of the survivors suffered injuries to their faces and spines, said Dr. Deborah Stein at the University of University of Maryland Medical Center’s shock trauma unit in Baltimore, where five of the injured were taken. Two were taken to St. Agnes Hospital, according to a statement from St. Agnes Healthcare. A spokeswoman for Sinai Hospital said one patient was taken there.

The Rev. Mike Murphy said the crash sounded like “one loud thump” from his room in the rectory of nearby St. Joseph’s Monastery, a Catholic facility.

Murphy said the busy thoroughfare “gets kind of crazy at times.”

Doreen Downs, who lives nearby, heard the crash and saw the wreckage.

“It’s just horrible,” she said.

Smith characterized it as an accident investigation, not a crime-scene investigation, despite the presence of homicide detectives. Smith said they were called because they are accustomed to conducting death investigations.

Associated Press