A 2010 study of mass shootings found that perpetrators die in 48 per cent of attacks — 38 per cent killing themselves, and the remaining 10 per cent at the hands of the police.
Of the 22 deadliest shootings in US history to date, the perpetrator has died in all but five cases, including Cruz's.
So what happens to those who survive?
MITCHELL JOHNSON AND ANDREW GOLDEN
Cousins Mitchell Johnson and Andrew Golden are the only living mass school shooters not currently in prison.
The pair was responsible for the Westside Middle School massacre, which saw four children and one teacher fatally shot outside an Arkansas school in 1998.
On the morning of March 24, they pulled a fire alarm at the school and fatally shot the victims as they exited the building using Golden's grandfather's rifles. Ten additional people were injured.
Johnson and Golden, aged 13 and 11 respectively, were among the youngest people ever charged with murder in American history.
The pair were found guilty of five counts of murder, and were both sentenced to confinement until the age of 21 — the maximum sentence available under Arkansas law. Johnson was released in 2005, and Golden in 2007.
The decision sparked a public outcry for tougher sentencing laws for juvenile offenders.
Both murderers have had trouble with the law since their release.
In 2007, Johnson was charged with possessing a firearm in the presence of a controlled substance. The following year, he was arrested again after stealing and using a debit card left by a customer at the gas station he worked in.
He was sentenced to 12 years in prison.
Golden changed his name to Drew Douglas Grant, and he too applied for a concealed handgun permit. Police denied his request.
Last year, a judge overseeing a civil lawsuit against the pair awarded $150 million to the families of the victims, ensuring the pair would never be able to profit from selling their story.
JAMES HOLMES
James Holmes was responsible for the Aurora movie cinema mass shooting during a midnight screening of The Dark Knight Rises on July 20, 2012.
He set off tear gas grenades and shot multiple firearms into the audience at the Century movie theatre in Colorado, killing 12 people and injuring 70.
Holmes, 30, was arrested in his car outside the cinema moments after the incident. He confessed to the crime but attempted to plead insanity.
His trial lasted 11 weeks, after which he was sentenced to 12 consecutive life sentences, plus 3318 years in prison.
Holmes was found guilty on all 165 counts against him. He avoided the death penalty because the jury couldn't reach a unanimous decision, and was instead sentenced to life in prison without parole at Colorado State Penitentiary, the highest security jail in the state. He was also ordered to pay $US954,878 ($A1.2 million) in restitution.
Holmes remains in prison. In 2015, he was attacked behind bars by fellow inmate Mark "Slim" Daniels. The incident occurred as he was being moved between cells.
As a result, he was transferred secretly to an undisclosed prison out of state.
In 2017, the Colorado Department of Corrections confirmed he had been transferred to a federal prison. He was listed at the Federal Correctional Complex in Allenwood, Pennsylvania.
Former prison guard George Emil Banks was responsible for shooting dead 13 people at his home in Wilkes-Barre, Pennsylvania.
On the morning of September 25, 1982, after a night of mixing straight gin with prescription drugs, Banks used an AR-15 semiautomatic rifle to kill eight people in his house.
The victims included four of Banks' own children, and three women who were girlfriends and mothers of them.
He also shot at bystanders who were across the street during the incident, before going to the home of his former girlfriend and their son. He killed them both, as well as his girlfriend's mother and nephew, who were also in the home.
When police found Banks, a four-hour standoff took place. On September 30, 1982, Banks was charged with eight counts of murder and a string of other crimes including car theft, robbery and aggravated assault.
During his trial the following year, Banks claimed he had only wounded his victims, and that police had killed them. At the end of his trial the jury recommended the death penalty.
Over the following years, Banks has remained in prison while attorneys continued to appeal his case. He was found mentally incompetent three times, with psychiatrists testifying that he was "psychotic, delusional and irrational".
In 2010, his lawyer said his mental health had deteriorated significantly since 1982, and he was ruled mentally incompetent for execution.
Today Banks, now 75, remains on death row in Pennsylvania.
NIDAL MALIK HASAN
In 2013, Army psychiatrist Nidal Malik Hasan was sentenced to death for killing 13 people and wounding 32 others in a 2009 shooting rampage.
The incident took place at Fort Hood, a US military post in Texas, and remains the worst mass murder at a military installation in American history.
Hasan carried out the shooting shortly before he was due to be deployed to Afghanistan. That morning, he gave away furniture and handed out copies of the Koran.
After the shooting, he was hospitalised under heavy guard in stable condition.
Hasan was charged with 13 counts of premeditated murder and 32 counts of attempted murder. The jury was given the option of agreeing to hand him a life sentence in prison, or the death penalty.
He appeared to be hoping for the death sentence to be given a path to martyrdom. The Judge responded saying: "[He] can never be a martyr because he has nothing to give ... Do not be misled; do not be confused; do not be fooled. He is not giving his life. We are taking his life. This is not his gift to God, it's his debt to society. He will not now and will not ever be a martyr."
After his sentencing, Hasan was incarcerated at the United States Disciplinary Barracks at Fort Leavenworth in Kansas to await execution.
Last year, Hasan declared he would go on a "99 pound hunger strike", according to Fox News.
Lieutenant General Sean MacFarland, the commanding general at Fort Hood, confirmed Hasan would not be dismissed by the army until his execution.
Howard Unruh was responsible for the first mass shooting in US history.
In 1949, he went on a 12-minute walk through his neighbourhood in Camden, New Jersey, and murdered 13 people — including three children.
At the end of his killing spree, he returned to his apartment and surrendered himself to the police waiting outside.
According to a psychiatric report, Unruh believed his neighbours were gossiping about his private life. The report said he was "a master of suppressed rage" with a "smouldering anger". He even kept a diary detailing all the things he thought people were saying about him.
Unruh was eventually charged with 13 counts of "wilful and malicious slayings with malice aforethought" and three counts of "atrocious assault and battery". He was also deemed insane, which made him immune to criminal prosecution.
He ended up in a private cell in a maximum-security psychiatric hospital. His chilling last words — uttered to a psychologist — were "I'd have killed a thousand if I had enough bullets."
After 60 years of confinement, Unruh died at age 88 due to health complications.
MARTIN BRYANT
Australia has not seen a mass shooting of this magnitude since the Port Arthur massacre.
Martin Bryant was 28-years-old when he murdered 35 people and injured 23 others after opening fire at the Tasmanian site in 1996.
Following the incident, he was judged fit to stand trial, and initially pleaded not guilty. Two weeks later, he was given 35 life sentences, plus 1035 years for other crimes.
What followed was decades of misery.
Bryant was initially held a in a special suicide-prevention cell, in almost total solitary confinement.
For the past three years, Bryant, now 50, has been housed in the maximum-security Risdon Prison in Hobart. Reports suggest he is not doing well; he's made multiple suicide attempts, remains in isolation, and is morbidly obese.