NEWARK, Del. - It wasn't real blood that spattered on the shoes of a girl in the front row, but some of the kids shrieked a little anyway. Shrieked, and giggled a bit, too.
But not for long.
"Get that tube in!" a doctor shouted. "He's losing a lot of blood!"
Leaning forward in their seats, students from George Read Middle School in New Castle, Del., craned their necks for a better look. This was a simulated emergency performed by staff at Christiana Hospital, but the youngsters knew it was based on the story of a real gunshot victim.
"Let's get him rolled over!" the doctor yelled. "I want to see those injuries."
The students watched as the surgical dummy was hoisted over, as pants were cut from the body, as more blood came gushing out, pooling on the floor. The staff worked feverishly as a monitor's line of light rose and fell. Until, finally, it rose and fell no more.
"I'm going to ask for 30 seconds of silence," the doctor said.
The staff went still. So did the kids.
For too many people, especially the young, violence is a fact of life on streets and in homes throughout the United States. Death by gunshots may soon surpass motor-vehicle deaths for Americans under age 25.
According to the Center for American Progress, children and teenagers in this country are 65 times more likely to be killed with a gun than their counterparts in the United Kingdom, seven times more likely than young people in Israel, and four times more likely than their peers in Canada.
The program's heart
More than 40 percent of all children and youth in the U.S. are exposed to violence, according to the Children's Hospital of Philadelphia.
More and more hospitals are working not only to save the lives of victims but also to prevent violence.
One of those efforts is Christiana's You Only Live Once (YOLO), the education program that brought the middle schoolers to the Newark hospital one day last month.
At the heart of the program is Brandon Lee Brinkley, a young man who was planning to become a barber when he was shot multiple times Dec. 6, 2008, three days after his 25th birthday. He died at Christiana. You Only Live Once is his story.
Hospital staffers have made it their story, as well.
"I don't want to have to tell anyone's parent or grandparent or brother or sister that you're never coming home," Amy Whalen, Christiana's emergency department assistant nurse manager, told the George Read students.
"I do this," she said, "because I don't want to have to do this anymore."
Health experts long ago declared violence in general and gun violence in particular to be among the nation's most pressing public-health crises, advocating that it be addressed like a disease to be eradicated, not an inevitability of life.
Hospitals in the Philadelphia area and nationally are trying a number of different antiviolence programs. At all of them, there is shared hope by doctors, nurses, social workers, and other care providers that their efforts can turn the tide.
"What I want people to think about is, 'When I pull the trigger, what are the consequences of these actions?' " said Scott Charles, Temple University Hospital's trauma outreach coordinator.
About 10 years ago, Temple started Cradle2Grave, a program that helped inspire YOLO, which Christiana Care Health System started in 2014. It is based on the shooting death of 16-year-old Lamont Adams of Philadelphia.
Temple's antiviolence programs include Turning Point, which offers counseling and support to victims of violence; Fighting Chance, which teaches community members how to try to keep gunshot victims alive until help arrives; and another initiative that provides gun locks to gun owners.
Children's Hospital of Philadelphia's offerings include the Violence Intervention Program, which focuses on patients who have been injured - victims as well as perpetrators - to bring them out of the cycle of violence.
"We work with families to find out what kinds of goals they hope to achieve," said Laura Vega, violence intervention specialist.
Cooper University Hospital in Camden began its four-part Traumatic Injury Prevention Program back in the 1990s. It takes youngsters through the aftermath of gun violence - from where trauma patients are treated, ending at the morgue.
"I get some very nice letters back from students," said David Groves, Cooper's outreach and injury prevention coordinator. Some of those students say the program has changed their lives, Groves said.
The National Network of Hospital-based Violence Intervention Programs has seen its member organizations grow in the last several years from about seven to 30, said spokeswoman Linnea Ashley, who also manages an antiviolence program in California.
The network, Ashley said, tries to seize on the "golden moment" when victims may be willing to accept help and change their lives.
The members include CHOP and Drexel University's Healing Hurt People, as well as programs from Canada and the United Kingdom. In the U.K., Ashley said, the assaults are more likely to be stabbings than gunfire.
Violence, however, is the common foe.
"People are seeing it as more preventable than intractable," she said.
As the students from George Read watched doctors reenact the failed struggle to save Brandon Lee Brinkley, a woman sat toward the back of the room, quietly dabbing at tears.
When Robin Brinkley White was asked whether the program could be built around her son, she didn't hesitate. She said that if the program saved even one life, "then his death wasn't in vain for me."
After the reenactment, the students heard more about Brandon, his family, and his life.
Chris Harris, 21, who almost did not survive getting shot, showed them his scars and his artificial leg replacing the limb doctors couldn't save.
"I was just like you all - a young kid. I was running, living the fast life," Harris said.
"I came out to show you it's real," said the Bear, Del., man.
Chaz Molins, a Christiana social worker who coordinates YOLO, handed the students toe tags and had them write down the names of people who would care if they were killed.
One of his great hopes is for the youngsters in the program to stop accepting guns and violence as an inevitable part of their lives and their communities.
"You guys are now the ambassadors for change," Molins told the students. "Because it's got to change."
Eight days after the YOLO presentation, the students got a reminder of how close violence always is.
Amy Inita Joyner-Francis, 16, died after a restroom assault at Wilmington's Howard High School of Technology, about 10 miles from Christiana Hospital. Three female students were arrested in connection with the beating death.
But even after that tragedy, students who had been at the Christiana program said that what they saw there had stayed with them.
"I think it would be good for some people who are going down the wrong path to see to let them know what could happen," said eighth grader Dwayne Earl, 14.
"When Brandon's heart stopped, it was just really emotional," said Zeynep Hebip, 14, another eighth grader. "I got teary."
Richelle Blue, 12, a seventh grader, said she couldn't get the program out of her mind.
"It made me think," she said, "it could happen to anyone."