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.

Officials said Wednesday they’d located everybody after hours of looking.

The police chief of Bristol Township said he’d “never seen such heroism,” and a speech therapist working there described feeling the building shake in Tuesday’s blast and hurriedly wheeling out a bed-bound resident, bed and all.

“They were running into a building that I could — from 50 feet away — could still smell gas, and walls that looked like they were going to fall down,” Police Chief Charles Winik told reporters Wednesday.

Responders spent hours digging through the badly damaged building and checking with hospitals into the night Tuesday to locate the missing. But officials said they didn’t yet know the cause of the explosion, even though a utility crew had been on site investigating a reported gas leak.

The blast sent 20 others to hospitals, including one person in critical condition. The rest of the 120 residents were transferred to nearby nursing homes, officials said.

The Bucks County coroner’s office said the employee who died was 52-year-old Muthoni Nduthu. Authorities didn’t immediately identify the resident who died at a Philadelphia hospital. Both victims were women.

Nduthu’s sister said she was a great mother to her sons, a great wife, a devout Catholic and very involved in the community. A Kenyan immigrant, she went to nursing school, loved to cook and was a hard worker, her sister, Rose Muema, said.

“She was an immigrant who came to make a difference in this country, and she did that,” Muema said.

Nineteen people were still hospitalized Wednesday, Winik said.

The explosion was so powerful that it shook nearby houses for blocks in Bristol, about 20 miles (32 kilometers) northeast of Philadelphia.

A wing of the facility with the kitchen and cafeteria was almost entirely destroyed, leaving the roof caved in, sections of walls completely missing and windows on adjoining walls blown out. Debris littered the grounds.

Winik said the scale of the casualties could have been much worse. Police and firefighters flooded in from the area, as staff from a hospital next door, nursing home employees and neighbors rushed to help evacuate people. One person was resuscitated at a hospital, officials said.

They found people trapped in stairways and elevator shafts and under rubble, authorities said. Some residents couldn’t walk, and some were in wheelchairs or bed-bound. A second explosion happed as rescues were underway.

Speech therapist Julia Szewczyk described the experience as terrifying and devastating.

She was in a group therapy session in another part of the building when it began to shake. She and other staff rushed to evacuate residents across a street to safety.

“And then the next thing was, to go inside and grab more people,” Szewczyk, 25, said.

They dragged out a bed-bound resident into the cold, then Szewczyk ran back into the burning building twice to grab blankets from a supply closet. One coworker got trapped inside an elevator when the power went out, she said.

Outside, during the rescue, employees had been looking for Nduthu, Szewczyk recalled.

Federal agencies were set to assist in the investigation, but the collapsed walls and roof needed to be cleared first, Winik said.

A utility crew was responding to reports of a gas odor when the explosion happened, authorities have said. The local gas utility, PECO, said the crew shut off natural gas and electric service to the facility, but didn’t know if utility equipment or gas was involved in the blast.

Musuline Watson, who said she was a certified nursing assistant at the facility, told WPVI-TV that staff smelled gas over the weekend, but did not initially suspect a serious problem because there was no heat in that room. Other employees told Szewczyk they smelled gas earlier in the day Tuesday, Szewczyk said.

The nursing home recently became affiliated with Ohio-based Saber Healthcare Group, which called the explosion “devastating” and said in a statement that facility personnel promptly reported the gas odor to the local gas utility before the blast.

Willie Tye, who lives about a block away, said he was watching a basketball game when he heard a loud boom.

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

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Levy and Scolforo reported from Harrisburg, Pennsylvania. Associated Press reporters Mingson Lau in Bristol, Pennsylvania; Holly Ramer in Concord, New Hampshire and Michael Casey in Boston contributed to this report.

Medicaid programs made more than $200 million in improper payments to health care providers between 2021 and 2022 for people who had already died, according to a new report from the independent watchdog for the Department of Health and Human Services.