The South Carolina State Paramedic Championship held its 40th competition at Kingston Plantation in Myrtle Beach.
Five EMS teams of two paramedics each competed to save lives in a mystery emergency situation.
The long-standing tradition has helped local paramedics' ability to save lives.
"I think the largest thing for me is remembering the ultimate goal, and that is to make an impact positively on every single life that we can," said Dorchester County EMS paramedic crew chief, Justin Wolfe. "When something ilke this is horrible, and as chaotic as it is, you just want to make a positive difference."
The teams had no idea what they'd be walking into, and Friday night's case was a prison riot.
They had 20 minutes to save injured prisoners, during a lockdown.
"It's very difficult," said Wolfe. "Everybody here has earned their spot. Everybody here has competed against the best of the best in their region to get here."
Bill Shivar, the EMS Symposium's competition coordinator, says the competition didn't start here.
"To start with, over 30 teams competing in the four regional offices, and then the regional champions get to come here, so we think it's best to praise and to acknowledge what we consider the best of the best each year," said Shivar.
Those regional offices, Spartanburg, Lancaster County, Dorchester County, and two Florence County EMS teams competed Friday.
One thing amped up the nerves for those EMS crews. The almost 600 people watching them compete.
"Being amongst all of your peers, so all these people know what you should be doing, and then fearing that you're not going to do those things," said Wolfe. "That's pretty, pretty chaotic."
The reigning champs for the SC Paramedics Championship are Hatfield and Herring with Florence EMS.
The winner for this year's competition will be announced Saturday at the Symposium.