The Clark County, Nevada, coroner released autopsy reports earlier this month detailing the deaths of the 58 victims of the Las Vegas shooting on Oct. 1.
The documents provide a window into the true horror of the massacre ― and of gun violence more generally. Looking through that window is admittedly uncomfortable, but doing so gives us a rare opportunity to honestly confront the graphic reality of a mass shooting. Shying away from that truth has only helped perpetuate a status quo in which many people have decided there’s nothing we can do to limit either the scope or the frequency of these tragedies. If that’s the path we continue to take, we should at least be willing to face up to the raw brutality of the incidents that we have accepted as an unavoidable feature of American life.
A number of the reports were difficult to evaluate due to inconsistencies in measurement, terminology and methodology, issues likely complicated by the sheer number of cases and the many different medical examiners who conducted the examinations.
HuffPost consulted with Arthur Alphin, a ballistics expert who specializes in the forensics of gunshot wounds and who has testified in a number of multiple shooting cases, to get his thoughts on a few of the cases. His comments are included in a number of the summaries below.
Case #1
Female
Cause of death: Gunshot wound to the head.
The bullet enters the right side of the victim’s head, creating multiple skull fractures and injuring multiple features of her brain, before reversing trajectory and exiting further down on the right side of her head.
Case #2
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the right side of the victim’s upper chest, coursing through his chest cavity and abdomen, before exiting on the lower left side of his back.
Case #3
Male
Cause of death: Gunshot wound to the back.
The bullet enters the left side of the victim’s back, coursing through his chest cavity before taking a slightly upward trajectory and exiting through his left chest.
Case #4
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left upper back, coursing through her chest cavity and causing injuries to the heart and lungs before coming to rest in the tissue of her right breast.
Case #5
Female
Cause of death: Gunshot wounds to the chest and forearm.
A bullet enters the victim’s upper right chest, striking a rib, perforating her right lung, diaphragm and liver, before coming to rest in the soft tissue of her lower right chest. Another bullet enters through the victim’s back right forearm, passing cleanly through and exiting the front of her arm.
Alphin believes both sets of injuries were caused by a single bullet that struck the victim on an unstable trajectory, likely because the overheated barrel of the gunman’s rifle had expanded from shooting so rapidly, sending rounds flying out more unpredictably.
“Dollars to doughnuts, this is the same bullet that does all of this,” said Alphin. “The round was probably unstable, meaning it was wobbling slightly in free flight. That’s why you’ve got that slightly oblong entry wound, that indicates a bullet that was wobbling from that overheated barrel. It enters the forearm, then it goes through and has an irregular exit wound to the anterior right forearm. ... Now the bullet is beginning to tumble [as it enters her chest].”
Alphin added, “I would think she was standing, she realized there were bullets coming, she put her arm up and a bullet struck her.”
Case #6
Female
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s lower right arm and passes cleanly through it into her chest, where it injures her right lung and ultimately strikes her vertebral column, shattering the bullet.
Case #7
Female
Cause of death: Gunshot wound to the right chest.
The bullet enters the victim’s right upper chest, perforating multiple features of her right lung, before coming to rest in the soft tissue of her central back.
Case #8
Female
Cause of death: Gunshot wounds to the head.
One bullet enters the victim’s left eye, injuring her eye and fracturing her skull, before coming to rest in the muscles on the side of her head. Another bullet enters the right side of the victim’s head, causing additional skull fractures and injuring multiple features of her brain, before coming to rest in the back of her head. The victim also suffered a gunshot wound to the hand and a graze wound to the shoulder.
Alphin explained how two separate bullets could have struck the victim in the head.
“Both of those head wounds would be instantly fatal, which means the person would drop to the ground like a sack of rocks. There’s no way, even if the guy had kept the rifle stable and these are bullets that sequentially exited the muzzle, you’re still talking a couple tenths of a second between impacts and the body would have started to drop. I’m thinking one of these hit the victim standing and one of them hit her laying on the ground. Remember, all the shooter is doing is spraying bullets.”
Case #9
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right chest between the ribs, perforating his liver, stomach and diaphragm, before entering his left chest. The jacket of the bullet is recovered in the victim’s left lung, while the bullet itself is found in the space between two ribs.
Case #10
Female
Cause of death: Gunshot wound to the head.
The bullet enters through the right side of victim’s head, fracturing the skull, fragmenting the bullet and causing massive injuries to the brain.
Case #11
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s right back and passes through her shoulder blade and into her chest cavity, perforating her right lung, heart and left lung, before exiting from her left chest. Clusters of cuts and bruises suggest the victim was either dragged or trampled after collapsing.
Alphin believes the bullet was wobbling when it struck the victim but says it’s hard to tell from the listed measurements.
“Once the bullet travels down through the lungs, that’s a fatal wound,” he said. “Trauma and internal bleeding.”
Case #12
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s left chest between his ribs, fracturing one of the bones and likely fragmenting the round, leading to perforations of his left lung, spleen, aorta, liver and right lung.
Case #13
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left back around her sixth rib, likely fracturing a bone before passing through her left lung and piercing the major arteries of the heart.
Case #14
Female
Cause of death: Gunshot wound to the head.
The bullet enters near the top of the victim’s head, fracturing her skull and causing massive hemorrhaging of her brain. Contusions on the victim’s face were likely the result of her falling forward after being fatally struck.
Case #15
Female
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right chest between her ribs, taking an upward trajectory through her right lung, aorta and across her midline, where it perforates her left lung and comes to rest in the tissue of her left shoulder.
Alphin believes the bullet was stable in flight when it struck the victim but became unstable upon entry.
“It basically hit perpendicular to the surface of the skin,” he said. “The bullet, as it’s precessing, probably clipped one of the ribs, and that’s why it’s unstable within the body and broke apart. That’s why there are fragments recovered.”
Case #16
Male
Cause of death: Gunshot wound to the head.
The bullet enters near the top of the victim’s head, coursing through his brain and into his neck before coming to rest in the tissue of his right shoulder. Additional abrasions suggest the victim fell after being struck and may have been dragged or trampled after collapsing.
Case #17
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s left upper chest at a downward angle, where it likely strikes a bone, which fragments the round, casting pieces throughout his left chest.
Case #18
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s right upper back, fracturing her third rib and perforating multiple features of her right lung and her aorta before coming to rest in the tissue surrounding her heart.
Case #19
Male
Cause of death: Gunshot wound to the neck.
The bullet enters the center of the victim’s neck, severing multiple vertebrae and major arteries before exiting through the left side of his neck. Abrasions on the victim’s arm and legs suggest he may have been dragged or trampled after collapsing.
Case #20
Female
Cause of death: Gunshot wound to the head.
The bullet enters the victim’s left cheek, fracturing her skull and passing through multiple features of her face before severing her spinal cord and coming to rest in the tissue of her neck.
Case #21
Male
Cause of death: Gunshot wound to the head.
The bullet enters the right side of the victim’s forehead, fracturing his skull, injuring his brain and shattering the round.
Case #22
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right upper chest, courses through his midline, passing through his carotid artery at the aorta and perforating his left lung before coming to rest in his lung tissue.
Case #23
Female
Cause of death: Gunshot wound to the head.
The bullet enters the right side of the victim’s head, injuring her right eye and brain before coming to rest in the left side of her brain. Another bullet enters through the back of the victim’s right forearm, injuring tissue but passing cleanly through.
Case #24
Female
Cause of death: Gunshot wounds to the head and leg.
One bullet enters the right side of the victim’s head, fracturing her skull and injuring multiple features of her brain while shattering the round. Another bullet enters the front of the victim’s left leg, injuring tissue before coming to rest in the back of her leg.
Case #25
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s central upper back, coursing through her vertebral column, shattering the round and sending fragments through her aorta and into her vertebrae.
Alphin says the autopsy indicates the bullet was in stable flight when it struck the victim perpendicular to the skin surface.
“The bullet began to break apart fairly quickly, and it completely disintegrated upon striking the vertebral body,” he said.
Case #26
Female
Cause of death: Gunshot wound to the neck.
The bullet enters the right side of the victim’s neck, coursing through the tissue of the neck and into the upper vertebrae, where the round is recovered.
Case #27
Female
Cause of death: Gunshot wound to the head.
The bullet enters through the left side of the victim’s forehead, fracturing her skull and likely the round, before passing through multiple features of her brain.
Case #28
Male
Cause of death: Gunshot wound to the chest.
The bullet enters through the victim’s right upper chest, striking his right collarbone and coursing through his aorta and left lung before striking a left rib and coming to rest in the soft tissue of his left upper back.
Case #29
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right chest, striking a rib and perforating his right lung, heart and left lung before exiting his left chest. Clusters of abrasions on the victim’s forearm suggest he was dragged or trampled after being struck.
Case #30
Male
Cause of death: Gunshot wound to the neck.
The bullet enters the right side of the victim’s neck, coursing through tissue in his upper neck and surrounding his vertebrae before striking his spine and coming to rest in the tissue of his left shoulder.
Case #31
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left back, coursing through the chest across the midline and exiting around her right breast.
Case #32
Female
Cause of death: Gunshot wound to the head.
The bullet enters the right side of the victim’s head, fracturing her skull and injuring her brain before exiting the left side of her head. Another bullet appears to have grazed the victim’s right wrist, causing damage to the tissue.
“That bullet was a .223 bullet, it was stable in flight and it was roughly perpendicular to the surface of the head,” Alphin said. “The only good thing is she didn’t suffer. She felt no pain at all. Some of those others, even though they died with the chest cavity wounds, they survived on the ground for 60 to 90 seconds, their heart continued to beat, the blood filled up into the pleural cavity and the thoracic cavity, their brain was still functioning and they knew they were dying and they were in pain. At least this poor woman, it was instant.”
Case #33
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right upper chest near the collarbone, coursing along the bone and through the body before coming to rest in the tissue of his upper arm.
“If a bullet enters or comes close to the long axis of a bone, the path of least resistance for the bullet is to skim along the bone, and so it actually follows the bone a little bit,” said Alphin. “As it’s dragging the side of the bullet alongside the bone that helps keep the bullet stable and nose on, and it’s easier to separate the flesh then, because it’s just being knocked away from the bone.”
Case #34
Female
Cause of death: Gunshot wound to the chest.
Bullet enters the victim’s left chest, striking and fracturing a rib, perforating features of the heart and right lung before coming to rest in the tissue of the right chest. Another bullet enters the back of the victim’s right elbow, passing through tissue and exiting the front of her arm.
Case #35
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left back, coursing through her body and coming to rest in the tissue of her left breast.
Case #36
Male
Cause of death: Gunshot wound to the head.
The bullet enters the right front of the victim’s head, injuring multiple features of the brain and coming to rest in the back of his cranial cavity. Another bullet enters through the victim’s lower leg, injuring tissue and coming to rest in the calf muscle.
Case #37
Female
Cause of death: Gunshot wound to the head.
The bullet enters the back of the victim’s head, damaging multiple features of her brain and causing bruising around her eye. Abrasions on the victim’s forehead and extremities were likely suffered when she collapsed in the moments after she was shot.
Alphin explained why victims who have been shot in the head with military-style rifles, which typically shoot bullets around three times as fast as a handgun, will often have bruising around the eyes.
“It’s very, very common that the eyelids will be bruised, because the eyeball was trying to be forced out of the head,” he said, adding that it’s even possible for these wounds to lead to the eyeball being ejected from the socket.
Case #38
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right chest, coursing through tissue, striking the right collarbone and perforating his right lung. Abrasions on the victim’s face and arms suggest he collapsed and may have been dragged or trampled.
Case #39
Male
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left upper back, coursing through tissue, striking a rib, perforating the left lung, heart and right lung before coming to rest in the tissue of the right chest wall.
Case #40
Female
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right chest between ribs, perforating multiple features of her right lung, her right diaphragm and liver before striking a vertebra and coming to rest in the soft tissue of her back. Abrasions on the victim’s body were likely suffered after she was shot.
Case #41
Male
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right upper chest near the shoulder, perforating his right lung, aorta and left lung, before coming to rest in the soft tissue between ribs in his left chest.
Case #42
Male
Cause of death: Gunshot wound to the head.
The bullet enters the right side of the victim’s forehead, fracturing the skull, fragmenting the round and injuring multiple features of his brain.
Case #43
Female
Cause of death: Gunshot wound to the chest.
The bullet enters the left chest, perforating her left lung, heart, right lung and striking a right rib before coming to rest in the soft tissue of her right armpit. Abrasions and contusions to the face and extremities suggest the victim collapsed and may have been trampled or dragged after being struck.
Case #44
Female
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right chest, coursing through tissue, perforating her right lung, heart and left lung before exiting through her left back.
Case #45
Female
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s right lower arm, passing cleanly through the tissue and exiting, before re-entering and re-exiting her arm and re-entering the victim’s body through her right chest. The bullet then courses through the victim’s diaphragm, strikes a rib, perforates her liver and strikes her spine before coming to rest near her lower vertebrae.
Alphin believes the bullet was unstable and tumbling when it struck the victim’s arm, which helps explain the strange path of the wound.
“I’m thinking that this person had their arm up at the shoulder but bent back at the elbow, as if scratching their ear or trying to shield their eyes or keep a hat from flying off their head.”
Case #46
Male
Cause of death: Gunshot wound to the head.
The bullet enters the right side of the victim’s forehead, injuring multiple features of his brain and ejecting a fragment of the bullet from the right side of his head.
Case #47
Male
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left lower back, coursing through tissue and entering the abdominal cavity before perforating his left kidney and left adrenal gland and casting fragments of the bullet along the wound path.
Case #48
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left mid-back, perforating her spine and coming to rest in her right chest cavity. Rib fractures suggest CPR was attempted at some point after she was shot.
Case #49
Female
Cause of death: Gunshot wounds to the back.
Two bullets enter the victim’s left lower back in close proximity, coursing through tissue and striking the lower spine, resulting in multiple fractures and shattering one of the rounds. The other bullet continues to course upward through the victim’s right lung before coming to rest in the right chest cavity.
Case #50
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s right chest, injuring vital structures in the chest cavity and coming to rest in the tissue of the right back.
Case #51
Female
Cause of death: Gunshot wound to the head.
The bullet enters near the top left of the victim’s head, fracturing her skull, fragmenting the round and injuring multiple features of her brain before exiting the right side of her head.
Case #52
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left upper back, fracturing a rib and perforating her left lung before coming to rest in the space between two of her vertebrae.
Case #53
Female
Cause of death: Gunshot wound to the chest.
The bullet enters the victim’s left upper chest near her collarbone, coursing through her chest cavity and exiting her back right shoulder.
Case #54
Female
Cause of death: Gunshot wound to the leg.
The bullet enters the victim’s right leg at the side of the knee, exiting slightly higher on the back of her right leg. The victim’s body is received with a tourniquet, suggesting a bystander attempted to stop the bleeding. Contusions and abrasions to the victim’s face, arms and legs suggest she may have been dragged or trampled after collapsing.
Alphin believes the victim was lying on the ground when she was struck.
“It’s very common with a bullet near the knee is that, as it breaks the knee and the tibial plateau ― that wider upper part of the tibia bone and lower end of the femur ― almost invariably a bullet doing that will sever the arteries and the veins that run through that part of the leg in order to feed blood to the calf and the foot. ... It probably hurt like hell. She may not have even known she was bleeding to death. Not uncommon. She feels down there, there’s a wound, there’s a little blood coming out. She says she’s hit. Ninety seconds later, she’s dead.”
Alphin added that the tourniquet may have been a sign that a veteran of either the Iraq or Afghanistan war attempted to stem the bleeding following a treatment protocol that has come back into favor in the U.S. military.
Case #55
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s left upper back, perforating her lung and heart, where it comes to rest.
Case #56
Male
Cause of death: Gunshot wound to the head.
The bullet enters the top left of the victim’s head, fracturing his skull and injuring multiple features of the brain, where it comes to rest.
Case #57
Female
Cause of death: Gunshot wound to the back.
The bullet enters the victim’s central upper back, coursing through her spine and chest cavity, before coming to rest in the tissue of her chest. Additional lacerations and abrasions of the face, legs and arms suggest the victim may have been trampled or dragged after collapsing.
“As soon as the bullet gets through the skin and the subcutaneous, it strikes the spine, which destroys the spine, sends fragments through into the lungs and basically destroys the bullet,” said Alphin. “And that’s why you’ve got fragments that exit the thoracic cavity. There’s enough velocity in those fragments that they hit the far rib cage wall and are found.”
Case #58
Male
Cause of death: Gunshot wound of the head.
The bullet enters the top left of the victim’s head, fracturing his skull and injuring multiple features of his brain before exiting near the entry wound.
Before You Go
