Alex Hribal, a teenage boy wielding two kitchen knives, reportedly went on a brutal stabbing rampage at his high school in Murrysville, Pa., on Wednesday.
Before being tackled by an assistant principal, authorities said, 20 students and a security officer at Franklin Regional Senior H.S. were either stabbed or slashed.
Hribal, 16, faces four counts of attempted homicide, 21 counts of aggravated assault and one count of possession of a weapon on school grounds.
He was arraigned as an adult and is being held without bail at the Westmoreland County juvenile detention center while the community is left reeling.
"I'm not sure he knows what he did, quite frankly," Hribal's attorney, Patrick Thomassey, said, adding he would file a motion to move the case to juvenile court.
"We have to make sure that he understands the nature of the charges and what's going on. It's important that he be examined by a psychiatrist and determined where he is mentally."
A doctor who treated six of the victims, primarily teens, said at first they did not know they had been stabbed, or whether their wounds were critical.
"They just felt pain and noticed they were bleeding," Dr. Timothy VanFleet, chief of emergency medicine at the University of Pittsburgh Medical Center, told CNN.
"Almost all of them said they didn't see anyone coming. It apparently was a crowded hallway and they were going about their business, and then just felt pain and started bleeding."
Arguing against bail for Hribal, the district attorney told the court that four of the victims were in critical condition, including one who was "eviscerated."
There's a question whether the victim will survive, according to reports.
Authorities have not detailed a possible motive in the attack, but the D.A. said in court the teen made "statements when subdued by officials that he wanted to die."
The carnage began shortly before the start of classes, when an attacker began stabbing students in a crowded hallway and then went from classroom to classroom.
Student Matt DeCesare was outside the school when he heard a fire alarm ring and then saw two students come out of the school covered in blood.
Then he saw teachers running into the building and pulling "a couple of more students out," he told reporters afterward. The students had been stabbed.
To stanch the bleeding, the teachers asked the students for their hoodies, which they "handed to the teachers to use as tourniquets to stop the bleeding."
Recordings of emergency calls released in the wake of the attack provide a soundtrack of sorts to the terror and chaos that played out inside the school.
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