Active shooter events and other mass casualty incidents, particularly ones involving an active threat, have been a steadily growing occurrence in the 21st century. In the past week alone we saw 7 active shooter events in 7 days across the USA. These events bring many cross-discipline providers from Law Enforcement, EMS, and Fire Departments together to effectively respond the the event. The hurdle in preparation for these events is that these providers seldom train together in these environments. System-wide procedures and protocols are only as effective as they have been practiced and implemented. Enter: Tactical Emergency Casualty Care Rural Environments (TECCRE)