Dozens of people have been injured as more than 130 vehicles were involved in a series of crashes in thick fog on the Sheppey crossing in Kent.
Eight of those hurt in the collisions, which took place at about 07:15 BST, have serious injuries.
Ambulance crews said 27 casualties needed hospital treatment and they dealt with 200 people at the scene.
Firefighters said they had freed five people from their vehicles on the southbound carriageway.
One witness said visibility had been very poor at the time of the crash but drivers were approaching the crossing with no lights.
Others at the scene described a mass of tangled cars, lorries, and a car transporter. Some reports said the crash went on for 10 minutes as cars continuously collided with each other.
The national speed limit applies to the dual carriageway crossing, with cars able to travel up to at 70mph, the Highways Agency said.
South East Coast Ambulance Service (Secamb) said eight people were seriously injured with a further 27 requiring hospital treatment.
A Secamb spokesman said a further 200 people were either treated for minor injuries or given advice should symptoms develop later.
Driver Martin Stammers said the scene was "horrendous" and described seeing cars under lorries and people lying on the floor.
He said visibility was about 10 to 20 yards when he approached the bridge and saw five cars smashed into each other with one across the outside lane.
He said he managed to squeeze through a gap between that car and the central reservation, he said.
BBC News
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