STORY CITY, Ia. — Cruising at 65 mph, Bob Libby has one of the fastest rides on the RAGBRAI route: an ambulance.

As medical director for the Register’s Annual Great Bicycle Ride Across Iowa, Libby coordinates the ride’s six medical vehicles and their personnel. He ensures injuries and issues are dealt with swiftly and riders stay safe.

“I describe it as a one-week family reunion,” he said. “There’s people that come up to us and say … ‘Hey, do you remember me? You took care of me last year.’”

Already it’s been a busy year, with 44 riders being transported to hospitals as of 5 p.m. Wednesday, many with heat-related illnesses and injuries, Libby said. The heat can intensify symptoms from underlying medical issues, he said.

During a typical RAGBRAI, 30 to 50 people end up in hospitals, and this year is bound to exceed that number, said Libby, who has worked on medical care for 12 RAGBRAIs.

While RAGBRAI is demanding for riders, emergency workers face the strain of 12-hour days, zigzagging across the route, racking up 300 miles or more while responding to locations based on only vague descriptions from riders.

“Is this the drive-through?” he joked as he pulled up next to a group selling pies in Zearing on Wednesday. He and his ambulance team, which includes a nurse and a physician, were on their way to the town’s community center to assist a woman who fell and hurt her arm.

Libby got the directions quickly and also asked how pie sales were going.

The team’s six medical vehicles include four ambulances, a motorcycle used for quicker responses, and a mobile emergency room bus operated by the University of Iowa. CARE, a private contractor, owns all of the ambulances and the motorcycle, and Libby works for the company as well.

The team of about 13 paramedics, physicians and nurses that man the emergency vehicles are the “cream of the crop,” Libby said. The unique challenges of medical care on the ride requires a certain skill level.

“When you’re out here, you don’t have the capability of always calling somebody for help,” he said. “You’ve got to be able to work on your own, you’ve got to be able to make a decision on your own, you’ve got to be able to take the heat.”

Even without all the tools of modern medicine being on-hand, riders still receive high-quality care, Libby said.

Riders who report to the emergency room bus with injuries (usually overheating or fractures to clavicles, wrists, ankles and ribs) are often released with teammates. But doctors will ask them to return to the bus over the following days to ensure that riders are healthy.

Beginning her first-ever stint working on RAGBRAI on Wednesday, Kim Hornbeck, 29, a sports medicine fellow at University of Iowa Hospitals and the physician riding in Libby’s ambulance, said she heard the stories of the ride’s culture, such as crazy costumes.

A Wisconsin native, Hornbeck didn’t know much about the ride until a training session with Libby and another experienced worker shortly before the ride. She said she enjoyed the opportunity to be seeing something new Wednesday, and things are going relatively easy.

“It’s a lot of fun,” she said. “You know, it’s a little bit overwhelming.”