The doctor in charge of treating child victims of the Texas church massacre has described his team's "gut-wrenching" battle to save them.
Seven surgeons scrambled to set up operating theatres as the victims of Devin Kelley's massacre were brought in fighting for their lives – with the children the most badly injured.
"The ballistic of the wounding, they are high velocity rounds. It causes a lot of tissue damage," said Dr Brian Eastridge, from San Antonio's University Health System.
The killer used a semi-automatic assault rifle to murder his victims, and Dr Eastridge told the New York Daily News the injuries were the sort normally found in a warzone.
"Seeing an injured kid, particularly when it's an injured child in your community, it's gut-wrenching."
Surgeons fought for hours to save one child.
Dr Eastridge told the NY Daily News: "The child went to the operating room, they had, amongst other things, blood vessel injuries to the abdomen…
"The efforts to save that child were heroic. They were there for about three and a half hours trying to save this child, sometimes actively doing CPR."
He said four children and five adults had been taken to San Antonio hospitals, but that they were unable to save one child.
Six people, aged from four to 57, are still in hospitals in San Antonio, with some "very critical".
Gunman Devin Kelley killed 26 people and injured 20 others when he opened fire in the First Baptist Church in the small town of Sutherland Springs on Sunday.
The youngest victim was 18-months-old, and the dead also included the unborn baby of one of the victims.
The US Air Force has said it has launched a review after failing to provide information that would have stopped the killer legally buying his guns.
Kelley, 26, was kicked out of the military over serious assaults on his wife and stepson.
The killer shot himself in his car after first being injured in a shootout with two local men who chased after him at high speed.
Police believe Kelley's killings were motivated by a domestic situation within his family and in-laws, and the motive was not religious or racial.