Quinzell Covington went on a shooting "caper" for the first time in the late 1990s with his cousins and friends. The tough guys who raised him in ways of the streets pulled the trigger that day

By 15, he was the one doing the shooting. Over the next dozen years, Covington learned to do it well. He used 9 mm guns that held 16 bullets and Mac-10 submachine guns. He lured victims to his turf, where he could scout for witnesses and surveillance cameras, in what he called his "Miranda check" - a macabre reference to the right to remain silent.

He also knew where to aim.

"If I shoot you in the leg, I know what I'm going to get, " said Covington, who is serving a 25-year sentence for murder. "If I shoot you in the stomach, I know what I'm going to get. If I shoot you in the head, I definitely know what I'm going to get. I'm going to get your demise."

Covington's evolution into a killer encapsulates a trend driving gun violence around the country: Increasingly, people are shooting to kill. Criminals are stockpiling higher-caliber guns, many with extended magazines that hold more than 20 bullets. Police and hospitals are seeing a growing number of victims who have been shot in the head or shot repeatedly. And trauma doctors are finding it more difficult to save gunshot victims.

In many places, if you get shot, you are more likely to die than ever before.

In Baltimore, one of every three people struck by gunfire dies, up from one death in every four shootings the previous decade. It ranks as one of the most lethal of America's largest cities, according to a Baltimore Sun analysis. Two other cities - Washington and New Orleans - shared the brutal distinction of one in three shootings ending in a homicide in 2015. Like Baltimore, several cities have seen the death grip tighten. In Chicago, one in 10 people died after being shot in 2000; now one in six perishes.

Last year, the odds for gunshot victims worsened in at least 10 of the nation's largest cities, The Sun found.

Researchers said lethality is a significant part of the homicide equation, with implications for policing, public health and trauma care, but in-depth study has been hampered by a paucity of statistics.

Historically, gun violence research in the U.S. has been inhibited by a lack of federal funding and data - many police departments only track what they are required to report to the FBI, which doesn't include how often people survive shootings, where on the body people are shot and how many times.

That leaves a focus on body counts and homicide rates, which can be traced back nearly a century. While the nation's overall violent crime rate declined, starting in the 1990s, a city's homicide rate typically fluctuates, sometimes significantly, leaving criminologists to puzzle over the causes behind spikes and dips.

Just five years ago, Baltimore public officials were celebrating a drop in the annual homicide count below 200. This year, that marker was crossed in August.

The latest crime wave in a number of cities - Baltimore, Chicago, Milwaukee and Washington, to name a few - has prompted deeper soul-searching. Deteriorating police-community relations have been blamed for a sharp increase in shootings and homicides, as have gang conflicts and entrenched societal ills such as segregation, poverty and joblessness.

But one often-overlooked trend has been consistent over the years, the Sun analysis found: Lethal force has become more so.

In Baltimore, where there were nearly 1,000 shootings last year, a one-in-four lethality rate means about 250 victims die. A one-in-three rate means more than 330 people die. So even if shootings subside, the number of gun deaths remains elevated.

On the streets, particularly in poor, black neighborhoods, residents are witnessing increasingly deadly tactics. More shooters are aiming for the head and firing multiple rounds into victims.

The number of fatal head shots rose steadily from about 13 percent two decades ago to 62 percent last year. Meanwhile, the number of cadavers with 10 or more bullets more than doubled in the past decade, according to the Maryland medical examiner's office, which tallied the bullet wounds at the request of The Sun.

Now, roughly two-thirds of city homicide victims are either shot in the head or multiple times. Many suffer both fates.

Guns have also become more deadly, as the weapon of choice for criminals and then law enforcement shifted from the revolver to the semiautomatic pistol, which can fire more bullets without reloading. Nationally, the number of 9 mm and .40-caliber guns taken off the streets surged during the past four years, as seizures of less powerful .22-caliber guns remained relatively flat.

In Maryland, seizures of 9 mm handguns overtook .22-caliber guns for the first time last year. Most were recovered from Baltimore's streets, where the saying goes: "Buy every gun that comes through; don't let it be the gun that kills you."

Many of the guns are equipped with extended magazines, allowing a shooter to fire from a distance and "walk down" a victim, continuously firing. The sale of "extendos" with more than 10 rounds is banned in Maryland, where they are prized in street cultures, tucked under belts and into pants as a fashion statement. In Baltimore, police are finding up to 80 shell casings at a single crime scene.

Metropolitan Police Chief Cathy L. Lanier, who retired last month after more than a decade in Washington, keeps a photo of a 100-round magazine seized by police on her cellphone as a reminder of the firepower out there.

Law enforcement officials across the country say they've observed insidious circumstances that are difficult to quantify. Reckless shootings in the daytime. Vigilante justice and contract killers. Gang rules that codify when violence should be used - and street rules limiting violence against bystanders being ignored.

"The criminals are more brazen, " said Baltimore police Maj. Donald Bauer, who leads the homicide unit.

While shooters' motives vary, experts and those caught in the crossfire note a ruthlessness on the streets where criminals with more sophisticated weaponry aren't just using guns to intimidate rivals or rob. They are using them to take people out with greater success.

In Baltimore and other cities with a deeply entrenched "no-snitching" ethos, the emphasis is on leaving behind no witnesses and no one to retaliate.

"It's very common for someone to walk up and empty a pistol at close range, " said criminologist David M. Kennedy, describing the "extreme" hold that gangs and drug crews have in cities like Baltimore, Washington and New Orleans. "It's going in with a heightened intent to actually kill you."

Those same criminals have honed strategies to keep weapons at the ready. Guns are stashed in trash cans, hung from gutter grates by string and stashed in other nooks where they can be quickly recovered when needed. (Covington says he kept part of his arsenal under an apartment complex's washing machine.)

Or people serve as "human holsters, " carrying guns for felons, according to Milwaukee Police Chief Edward A. Flynn.

And in Baltimore, hit men for hire have become fixtures on the streets.

Police recently began tracking the so-called 10 Grand Club, an organized gang of hit men willing to kill for that price, and prosecutors say that's double the typical fee. (Covington became a contract killer but also says he "killed out of friendship" for free if a woman approached him about taking out her rapist or her child's molester.)

Not even decades of advancements in trauma medicine can stem the carnage.

Even as patients with major injuries from other assaults and car accidents have seen their chances improve dramatically, gunshot victims have watched their chances of survival plummet. Studies by hospitals and trauma centers across the country, including Baltimore's top-ranked medical systems, have documented this contrarian trend.

"We feel this represents a true change in violence intensity, " researchers with the Johns Hopkins Medical Institutions concluded a decade ago. Doctors say it has gotten worse since then.

This has left communities nationwide reeling, with violence concentrated in traumatized neighborhoods where mothers are forming support groups, not only to help each other cope but in a desperate search for ways to stop the killing. A nationwide network of grief is starting to take shape, with more support groups banding together and becoming politically active.

"We're all facing similar dynamics, " said Corneilius Scott, who volunteers as executive director of Mothers of Murdered Sons and Daughters United in Baltimore. "There's a lot of concern and not many answers."

At the group's meetings, parents are talking about "sensitizing" young men to the effects of violence. They believe - and social science is finding - that their boys need to be taught empathy, lest they become trapped in a cycle, repeatedly exposed to violence and becoming more likely to commit it.