Two people have died in a multi-vehicle crash on the Pacific Highway at Nabiac on the New South Wales Mid North Coast.
Four other people were injured and taken to hospital following the crash just before 10am on Monday.
Police say it appears a Nissan SUV and Toyota LandCruiser pulling a caravan crashed before the SUV hit a prime mover.
Two people inside the SUV died at the scene.
They have not been formally identified.
A man, 42, a 43-year-old woman and two children aged eight and nine who were in the LandCruiser were taken to John Hunter Hospital in Newcastle.
The driver of the prime mover was not injured but was taken to hospital for mandatory testing.
One of two north and southbound lanes of the Pacific Highway remained closed while police investigations continue.
Five deaths in seven days
Monday's fatal crash follows the deaths of three people in two driving incidents less than 48 hours apart on the Mid North Coast last week.
One driver died and three passengers were injured after an SUV left the road and hit a tree near Taree on March 31.
Two people died after a ute and a truck collided at Yarras, west of Port Macquarie, on April 2.
The fatalities have sparked renewed calls for road safety awareness by community advocates.
Taree resident Diane McMurtrie started the road safety charity Hannah's Blue Butterflies after her daughter was killed in a road incident at Taree in 2013.
Ms McMurtrie said the recent fatalities would have lasting impacts in the small communities on the Mid North Coast.
"When crashes happen in our own area, most definitely you see the ripple effect," she said.
"People are shaken and upset by these tragedies."