On August 5, 2010, in Gray Summit, Missouri, traffic slowed in the approach to an active work zone on eastbound Interstate 44. A 2007 Volvo truck-tractor with no trailer was traveling in the right lane and had slowed or stopped behind traffic. About 10:11 a.m. central daylight time, a 2007 GMC Sierra extended cab pickup truck merged into the right lane and struck the rear of the Volvo tractor. This collision was the first in a series of three. Two school buses from St. James High School, St. James, Missouri, were approaching the slowed traffic and the collision ahead. The lead bus was a 71-passenger bus, occupied by 23 passengers. Following closely behind the lead bus was a 72-passenger bus, occupied by 31 passengers. Seconds after the lead bus passed a motorcoach that had stopped on the shoulder, it struck the rear of the GMC pickup. This collision–the second in the series–caused the pickup to overturn onto the back of the Volvo tractor. The front of the lead bus came to rest on top of the GMC pickup and the Volvo tractor. Moments later, the following bus struck the lead bus. As a result of this accident sequence, the driver of the GMC pickup and one passenger seated in the rear of the lead bus were killed. A total of 35 bus passengers, the 2 bus drivers, and the driver of the Volvo tractor were injured. Eighteen people were uninjured. Major safety issues identified in this investigation were the potential use of video event recorder data in monitoring and oversight of driver performance; driver distraction due to use of a portable electronic device; necessity of maintaining adequate focus on the forward roadway and keeping recommended minimum following distance; medical oversight of interstate commercial drivers; inadequate Missouri state school bus inspection regulations and procedures; absence of Missouri state oversight of motor carriers involved in pupil transportation; frequency of rear-end accidents; design of emergency exit windows on school buses; and absence of a Missouri state requirement for pretrip safety briefings for pupils traveling to an activity or on a field trip in a school bus or a school-chartered bus. The National Transportation Safety Board makes recommendations to the National Highway Traffic Safety Administration, the 50 states and the District of Columbia, the state of Missouri, the Missouri Department of Elementary and Secondary Education, CTIA—The Wireless Association, the Consumer Electronics Association, the National Association of State Directors of Pupil Transportation Services, the National Association for Pupil Transportation, and the National School Transportation Association.