Mass shootings can happen anywhere - that's the mindset many emergency agencies have these days.
Cape Girardeau Police and Fire both say they continually train for a mass casualty event, but it's something they hope to never have to use.
"We want them to be prepared for the absolute worst," Cape Girardeau Police Chief Wes Blair said of his officers.
He said he doesn't take lightly the possibility of a shooting - like the one that left 49 dead in Orlando - from happening in the Heartland.
"One of the few things that keeps me awake at night is just that, worrying about an active killer incident," Blair said.
With mass shootings around the country on the rise, training first responders are increasing, as well.
"Our patrol officers going through active shooter training every year," Blair said. "They are tactically trained on how to deal with those types of situations and we always try to keep that training fresh."
A large part of that training is collaborating with other agencies, like the Cape Girardeau Fire Department.
"We're going into that warm zone behind law enforcement," Asst. Fire Chief Mark Hasheider said.
He said in active shooter situations, fire fighters would have the added protection of a ballistics vest.
And they're training largely focuses providing first aid.
"All of sudden we may have one fire fighter, paramedic, EMT treating a number of people as we can," Hasheider said.
To prevent loss of life, responding to an active shooter takes team work.
"If you train together then you know what to expect of each other," Blair said.
First responders say they look at incidents like the Orlando shooting and see what worked and what didn't and adjust their training as needed.