The crash occurred at about 12:30 p.m. on the New York State Thruway near Pembroke, about 30 miles east of Buffalo. The cause was under investigation and did not appear to involve a mechanical failure or impairment of the driver, Maj. Andre J. Ray of the New York State Police said at a news conference.

Investigators believe the driver, who survived and was not identified, became distracted, lost control and overcorrected, causing the vehicle to roll over into a ditch, Major Ray said. The bus was the only vehicle involved in the crash.

The National Transportation Safety Board dispatched a team of investigators to the crash site, a spokesman said. They were expected to arrive Saturday morning.

A State Police spokesman, Trooper James O’Callaghan, had said earlier in the day that a child was believed to be among those killed, but Major Ray said at the news conference that all of those killed were adults. Their names were not immediately released.

The bus had 54 people on board at the time of the crash, Major Ray said. Fifty-two were passengers; two, including the driver, worked for the bus operator, which Major Ray identified as M&Y Tour Inc. of Staten Island. Calls to the company went unanswered on Friday, and an email request for comment was not immediately returned.

Trooper O’Callaghan had said that the bus was traveling at “full speed” when the driver lost control. Asked to clarify how fast that was, Major Ray declined to comment, saying he did not have information about the bus’s speed.

Every passenger on the bus had at least some sort of “cut, bruise or abrasion as an injury,” Trooper O’Callaghan said. Most of the passengers, Major Ray said, were from outside the United States, including India, China, the Philippines and Middle Eastern countries. Many were ejected when the crash occurred, he said. Trooper O’Callaghan had said earlier that it appeared many passengers were not wearing seatbelts.

By midafternoon, the seriousness of the crash was clear from the flashing red and yellow lights of the more than three dozen emergency vehicles lining both sides of the highway as the rescue operation continued.

At around 3 p.m., several firefighters set up a black tarp to shield one side of the bus from public view. Reporters and other onlookers were kept hundreds of feet away.

Gov. Kathy Hochul said in a statement on X that she had been “briefed on the tragic tour bus accident” and that her office was “coordinating closely” with the State Police and other agencies that were responding to the crash.

At a news conference at Erie County Medical Center, one of the hospitals where injured passengers were taken, Dr. Samuel Cloud, the chief medical officer, said the crash was “probably the most trauma patients from one incident in my career here in Buffalo.”

The 24 patients brought to the hospital had head injuries, broken extremities and internal injuries, Dr. Jeffrey J. Brewer, the head of surgery, said.

Dr. Jennifer L. Pugh, the medical center’s chief of emergency medicine, said 20 crash victims were still being treated as of 4:30 p.m., including two who were in surgery.

With the victims being of various nationalities, the hospital had brought in 15 to 20 translation devices to communicate with them, Dr. Pugh said. Some of the patients spoke English and were able to communicate with doctors more easily.

Six people were treated at the University of Rochester Medical Center, including two who had sustained critical injuries and four, including a child, who were “medically stable,” the hospital said in a statement.

Margaret Ferrentino, the president of Mercy Flight, which provides emergency air transport to hospitals, said the organization’s helicopters had made multiple trips from the crash site to local medical centers.

By 2 p.m., helicopters had taken two injured children to Oishei Children’s Hospital in Buffalo, one adult to Erie County Medical Center in Buffalo, and another adult to Strong Memorial Hospital in Rochester.

“I think we will be busy for a while here,” Ms. Ferrentino said. “It is a multiagency response, both air and ground.” She added: “I pray for the victims and for the safety of the responders.”

After being shut down for several hours following the crash, the westbound lanes reopened shortly after 5 p.m., closed again briefly and then reopened again at about 5:45. The eastbound lanes remained closed.

Shortly after 6 p.m., under a still-blazing sun, a large truck began to pull the bus from the grassy area where it had rolled onto its side. And as dusk fell a little more than an hour later, an industrial-size tow truck hauled off the vehicle, its scarred exterior, smashed windows, and broken luggage bay doors offering evidence of what its passengers had endured.

By 8:30 p.m., several of those passengers were at a senior center in a quiet, tree-lined section of Buffalo that had been set up as discharge point for those who had been released from the hospital and a gathering place for their families.

From there, said Mark C. Poloncarz, the Erie County executive, the victims would be taken to hotels to spend the night. Others remained in hospitals, continuing to recover, some with family members at their side, he said.

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