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By Sky News US Team
Four people have died and 12 others are in a critical condition following a crash involving an amphibious tour bus in Seattle.
The Ride the Ducks vehicle collided with a charter bus carrying foreign college students on a bridge.
The city fire department said 44 patients were taken to hospital with a mixture of critical and serious injuries.
Firefighters and medics evaluated some 50 people for injuries at the accident scene.
A witness told the Seattle Times the side of the bus was torn off as the duck boat ploughed into it.
Jesse Christenson said the duck boat careened across a lane on the Aurora Bridge over Lake Union at 11.15am local time.
"Then all of a sudden the duck boat turned sharper into the left," he said. "I initially thought it was a blow out.
"The duck boat then hit another car with a roof rack then went head on into the oncoming tour bus."
Students and staff from North Seattle College's International Program were involved in the deadly crash.
Jahna Dyer, a registered nurse, said she found victims lying on the road alongside twisted metal and shattered glass.
She said she helped stabilise an injured man's neck and treated a woman who had a cut lip and glass in her eye.