My wife and I first came to Wichita Falls in 1993. As part of learning about the city we read about a bicycle event called the Hotter 'n Hell something or other. During this event, thousands of allegedly sane individuals mounted their bicycles and pedaled for up to one hundred miles during the hottest part of the year. I thought this the height of foolishness but probably good for business.

The foolishness must be contagious, however. I now find myself, after four years of participating in the ride and working medical stops, taking over as Medical Director and trying to keep up the high standards of the past.

The Hotter 'n Hell Hundred is a major event which has received volunteer support from all segments of the population. From the first ride of only 1,100 riders to the recent rides of 8,000 to 10,000 riders, medical volunteers have been instrumental in making the race possible. The safety record at the HHH is exemplary. Out of over 120,000 riders only five deaths occurred, the last one in 1994 in a rider with a severe cardiomyopathy. In 1988, the HHH was the first event to require protective helmets for all riders, an action adopted my many other national rides since then. Before the ride begins eighteen rest/medical stops are set up including the medical tent at the finish line. During the early part of the ride the rest stops come approximately every ten miles. During the latter part of the course, the stops are about five miles apart.

The supplies required for the riders are staggering. Sponsors contribute over 20,000 bananas, 9,000 oranges, over 5,000 gallons of PowerAde (TM) replacement drink, 10,000 gallons of water, and 70,000 pounds of ice to the rest stops.

Heat related injuries are seen most commonly by medical personnel. Every year, however, trauma related injuries occur from collisions and accidents. The usual pattern is to see trauma early in the ride, and heat related injuries later in the day. To deal with the trauma, various protocols were developed by the volunteers. This year, we will have protocols for dealing with road rash, wound care, insect bites, snakebites, and dog bites in addition to protocols for IV fluid resuscitation, transfer procedures, and infection control.

Wet Bulb Globe Temperatures will be measured at two different sites along the course to aid in prevention of heat injuries. In the HHH, we must bend the rules a little, though, since the WBGT usually averages higher than the 85 degrees Fahrenheit textbooks say is the level to curtail outside activity. This illustrates the increased demands of the riders here, the need not just to condition but also to heat acclimate. Each year we see well-conditioned athletes who recently rode a century in a cooler climate stagger into a medical tent unable to go further because they were not able to deal with the increased demand the heat in Wichita Falls imposes. The most consistent predictor of heat injury is wind, not heat. The years with the wind speed greater than 20 mph see the most heat related injuries, not the years with the highest WGBT.

Most of the riders with heat related injuries recover with nothing more than cooling and oral fluid rehydration. Some riders require IV rehydration. Those who require IV rehydration cannot continue the race. Early in the race injured riders receive D51/2NS. After 11:00 AM any rider requiring IV therapy receives D5NS to prevent hyponatremia. To prevent heat related injury we advise riders to drink at least two bottles of fluid between each rest stop. Riders with large volume systems such as Camelbaks (TM) tend to have an easier time rehydrating. The key is to drink before thirst develops. After the rider becomes thirsty it is difficult to catch up. Riders are advised to drink by a schedule, not by thirst. Cooler fluids are absorbed faster. Sports drinks containing electrolytes help to avoid hyponatremia. Solutions of four to seven percent carbohydrates are absorbed at the same speed as water. More concentrated solutions are absorbed more slowly.

The Hotter 'n Hell Hundred is the largest event of its kind in the state. Because of the hard work and dedication of the volunteers it is one of the most well run of such events. We will continue to make it one of the safest.