NSW special operations team (SOT) paramedics face possibly life-altering, snap-decisions at every call-out.

Andrew Crew, who has been a paramedic for 22 years, runs SOT training days, ingraining team procedures and vital details that help avoid costly mistakes.

"We'll try and make it as realistic as possible, based on other incidents that have happened in the area or in the wider state," Mr Crew said.

In the NSW Riverina region, Mr Crew and SOT paramedics are training vertically from a bridge, recreating a dangerous treatment environment.

"We'll have a patient that will be on the side of a cliff face or an industrial setting and we'll make the officers problem solve and perform that rescue," he said.

The team was also tasked with rescuing a live patient suspended from a gantry in a silo industrial setting and entering a confined space filled with artificial smoke to create sensory deprivation.

"Which can be a little bit distressing," Mr Crew said.

"It teaches them, in a controlled environment, ways to still access and focus on patient care and thinking about plans and forward thought of extrication."

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But getting into the highly competitive rescue team means rigorous testing and training, including a fitness requirement, mechanical aptitude testing and an eight-week course.

But one life threatening safety breach and recruits are out.

NSW paramedic Elliot O'Keeffe recently graduated from the "physically and mentally intense" rescue training course.

"Eight weeks of totally new skills, concepts, leadership and team management," Mr O'Keeffe said.

The new rescue paramedic didn't take the responsibility lightly, knowing he'd face situations requiring him to remain cool under pressure.

"We all try to be," he said.

"That's what comes from this training and the eight weeks of training, having confidence in the process, your own skills, abilities and your equipment.

"One less thing you can remove from your mind whilst you're treating."

It didn't take long for fellow paramedic Amy Barclay to use rescue training like abseiling after graduating from her course.

"It was actually my first job, I had to put on my harness," Ms Barclay said.

"We had a 13-year-old girl who climbed a tree and couldn't get down - it was a very, very big tree."

Since then, Ms Barclay said she went out on two to three rescue calls a week, for anything from freeing someone trapped in a public bathroom to emergency motor vehicle crashes.