A 16-year-old boy who stabbed 20 people in a bloody 30 minute rampage at a high school was eventually subdued by a school security guard and an assistant principal.
At least four students were seriously injured at Franklin Regional High School in Murrysville, Pennsylvania, when the student, who police said was "flashing two knives around", carried out the assault.
Thomas Seefeld, chief of police in the suburb 15 miles east of Pittsburgh, said the 16-year-old walked down a hallway and ended up stabbing 19 fellow pupils and security guard as they began arriving for what should have been a normal school day.
The assault began at 7.13am (12.13 GMT) and was over by 7.45am.
The school was locked down and students were kept inside while officials checked the premises was secure.
A motive has not been established.
Forbes Regional Hospital is treating eight of the victims. Doctor Mark Rubino said he expected everyone to survive, despite "deep penetrating" stab wounds.
Three victims are in surgery there, while the other five are still being evaluated.
Dan Stevens, a spokesman for Westmoreland County emergency management, told AFP the teenage victims are aged 14 to 17.
Mr Stevens said some of those injured suffered cuts and scrapes as they attempted to flee the scene.
Twelve victims have been sent to four different hospitals.
One student told the television channel WTAE he saw "students holding their stomachs, bleeding."
Morris Hundley said his 14-year-old daughter Morriah called him in tears. He rushed to the school still wearing his slippers, hoping for more information.
"My first thoughts were I think we need to home school now that this has happened," he said.
"The words can't describe how I feel. I'm just thinking of the victims."
Mr Seefeld praised staff, telling a news conference things could have been much worse "if there was not (the) immediate interaction that occurred".
The attack follows on from a long line of US school shootings that have provoked a nationwide debate about gun control laws.
The December 2012 massacre at Sandy Hook Elementary School in Newtown, Connecticut, which claimed the lives of 20 children and six adults, failed to tighten the rules surrounding gun ownership.
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