Pennsylvania Gov. Josh Shapiro said in a later news conference that emergency responders braved the flames, a heavy odor of gas and a second explosion to evacuate residents and employees.

Fire officials said they were in “rescue mode” five hours later, with responders still digging by hand and using search dogs, earth-moving equipment and sonar to locate potential victims.

The explosion happened at Bristol Health & Rehab Center in Bristol Township, just as a utility crew had been on site looking for a gas leak.

Shapiro said a finding that a gas leak caused the explosion was preliminary.

A plume of smoke rose from the nursing home as emergency responders from across the region rushed there.

Authorities did not identify those who died and did not immediately know the total number of people injured.

The town’s fire chief, Kevin Dippolito, said at the Tuesday evening news conference that five people were still unaccounted for, but he cautioned that some may have left the scene with family members.

Shapiro asked his fellow Pennsylvanians to take a moment to pray “for this community, for those who are still missing, for those who are injured, and for those families who are about to celebrate Christmas with an empty chair at their table.”

Dippolito described a chaotic rescue where firefighters found people stuck in stairwells and elevator shafts and pulled residents out of the fiery building through windows and doors. Two people were rescued from a collapsed section of building, he said.

Firefighters handed off patients to waiting police officers outside, including one “who literally threw two people over his shoulders,” Dippolito said. “It was nothing short of extraordinary.” A second explosion erupted during the rescue, he said.

Bucks County emergency management officials said they first received a report of an explosion at approximately 2:15 p.m.

Willie Tye, who lives about a block away, said he was sitting at home watching a basketball game on TV when he heard a “loud ka-boom.”

“I thought an airplane or something came and fell on my house,” Tye said.

He got up to go look and saw “fire everywhere” and people escaping the building. “Just got to keep praying for them,” Tye said.

The local gas utility, PECO, said while its crews were responding to reports of a gas odor at the nursing home, an explosion happened.

“PECO crews shut off natural gas and electric service to the facility to ensure the safety of first responders and local residents. It is not known at this time if PECO’s equipment, or natural gas, was involved in this incident,” the utility said in a statement.

One worker sustained non-life-threatening injuries, the utility said.

Investigators from the Pennsylvania Public Utility Commission’s went to the scene. Finding that the explosion was caused by a gas leak won’t be confirmed until the agency can examine the scene, a utility commission spokesperson said.

Musuline Watson, who said she was a certified nursing assistant at the facility, told WPVI-TV/ABC 6 that, over the weekend, she and others there smelled gas, but “there was no heat in the room, so we didn’t take it to be anything.”

The 174-bed nursing home is about 20 miles (32 kilometers) northeast of Philadelphia. It is newly affiliated with Saber Healthcare Group and had been known until recently as Silver Lake Healthcare Center.

In a statement, Saber called the explosion “devastating.” It said facility personnel had promptly reported a gas smell to PECO before the explosion and that it was working with authorities to ensure the safety and well-being of staff, residents and the community.

The latest state inspection report for the facility was in October, and the Pennsylvania Department of Health found that it was not in compliance with several state regulations.

The inspection report said the facility failed to provide an accurate set of floor plans and properly maintain several stairways.

It said the facility failed to maintain portable fire extinguishers on one of the three levels and failed to provide the required “smoke barrier partitions,” which are designed to contain smoke on two floors.

According to Medicare.gov, the facility underwent a standard fire safety inspection in September 2024, during which no citations were issued. Medicare’s overall rating of the facility is listed as “much below average,” with poor ratings for health inspections in particular.

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Levy and Scolforo reported from Harrisburg, Pennsylvania. Associated Press reporters Holly Ramer in Concord, N.H., Michael Casey in Boston and Hannah Schoenbaum in Salt Lake City contributed.