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Pedestrian Killed, Others Seriously Injured In 'Horrific' Truck Crash

Police have been unable to reach the body of a woman who was killed in a "horrific" truck crash in Sydney's inner south. 

Five others were injured after a B-double truck swerved into a power pole before careering into a group of pedestrians waiting for a bus in Alexandria on Wednesday morning.

The truck then crashed into an abandoned building, causing it to partially collapse. It's believed the woman, who died at the scene, could be trapped in the rubble.

"It's very close to Christmas, a time where we usually get together with friends and family," NSW Ambulance Acting Superintendent Steve Vaughan said.

"Unfortunately, there is at least one person who won't be doing that."

One woman was killed and others injured in a truck crash in Alexandria. Image: AAP

Up to 22 ambulance personnel responded to the crash on Botany Road, near Green Square railway station, about 7.45am.

Supt Vaughan said the first paramedics arrived to an "absolutely horrific scene".

"'They were able to identify a truck driver who was trapped in his vehicle, multiple people laying on the footpath and two others still sitting in vehicles," Supt Vaughan told reporters, adding the patients were strewn over 50 metres.

Paramedics treated six people, including the driver who was trapped for 45 minutes with parts of the truck compressing  his legs.  He and another female pedestrian were taken to hospital with critical injuries.

"(The driver)may have had a medical episode, but that is yet to be confirmed," NSW Police Superintendent Andrew Holland said.

"An investigation will either rule that out or in. He's obviously in shock."

Another two people suffered serious injuries and were transported to hospital in a stable condition.

Supt Vaughan said crews had been unable to reach the female pedestrian who died at the scene and is believed to be under the collapsed building.

Supt Holland added a number of people could still be trapped inside.

The horror crash has impacted large teams of paramedics and ambulance personnel who will be monitored in the coming days.

Lord Mayor Clover Moore said City officials will work with police to understand what happened.

“A safe city is a city that is designed for people," she said in a statement.

"As our city continues to evolve and change, we’ll continue to work with residents and the NSW Government to advocate for lower speed limits and for streets that are safe for all road users, especially pedestrians.”

A City of Sydney Council building was damaged in the crash, however no one was inside.

In the lead up to Christmas, Supt Vaughan urged drivers to be careful on the roads.

"You want to spend it with your loved ones. Please slow down and take care," he said.

Botany Road remains closed in both directions between Bourke Street and Epsom Road, prompting significant delays in the area.

Northbound traffic is being diverted into Collins Street and southbound traffic into O'Riordan street, while several bus routes are diverting traffic via local streets.

Motorists are being advised to stay away from the area, while those already nearby should allow plenty of extra travel time.

Anyone with information about this incident is urged to contact Crime Stoppers: 1800 333 000 or online