Over the past 20 years, the public safety approach to high-threat mass casualty incidents such as an active shooter event has undergone significant changes. The initial change was with law enforcement; they no longer wait at the perimeter for specialized units to arrive on the scene and manage these high-threat incidents, instead shifting to a very aggressive initial response, which has resulted in a significant decrease in the amount of time until these situations are brought under control. This change was necessary to “stop the killing.” The next very important paradigm change rests in the hands of fire and EMS personnel to “stop the dying.” From this need, the Rescue Task Force concept was born with the framework of risk/benefit analyses and combat-proven evidence-based medicine, allowing for point of wounding care to occur. This saves the crucial seconds and can extend the life clock of the injured until further definitive care is available. The Rescue Task Force is about integrating tactics, allowing for a cohesive response. This class will look at lessons learned from past incidents to establish an understanding of the methods and tactics involved for a successful Rescue Task Force integration. Further discussion involves patient care considerations when operating in a high-threat environment, how traditional medical protocols often fail to allow for the aggressive care required for optimal patient survivability, and how adopting Tactical Emergency Casualty Care (TECC) guidelines will help overcome this obstacle.