After three years of working the Sturgis rally, paramedic Shawn Fischer knows what to expect this week: a deluge of illnesses, stabbings and motorcycle wrecks, some likely fatal.
Fischer, 41, is director of Sturgis Ambulance and has seen her share of incidents in her 20-year career as a nurse and paramedic. But whatever she handled throughout the year, nothing can compare to the volume and variety of incidents she will respond to during the rally.
"It's something we train all year long for," she said.
Fischer is directing 32 people, from EMTs to paramedics, to tend to rally-goers. Her crews are supported by a bevy of medical professionals from other agencies as Sturgis temporarily swells from a town of 7,000 to a city of about 400,000.
Fischer still remembers her first rally in 2009, shortly after joining Sturgis Ambulance as a paramedic. She had never seen such a wide variety of incidents.
"It was everything," she said. "Medical calls, to motorcycle accidents, to stabbings — it's a chance for EMTs and paramedics to see every part of their job."
That feeling of being prepared and knowing that intensive training will almost certainly be put to good use, makes the annual rally something Fischer greets with trepidation but also anticipation.
"We don't dread it at all," she said. "I think we all look very forward to it. It's excitement for us."
Scott Lensegrav, 41, an emergency medical technician for Sturgis Ambulance and the Rapid City Fire Department, said he has seen the pattern of motorcycle accidents change over the years.
Lensegrav has worked the rally for 12 years. He remembers a phenomenon during rally week that emergency personnel called "Black Wednesday."
On that rally day, bikers heading home after the first part of the rally would collide with bikers heading into town for the second half.
"It always seemed like we had more accidents that day," he said.
That Wednesday trend seems to have ebbed, and so, too, has the number of accidents on dangerous routes like Boulder Canyon Road, which was once a hot spot for mishaps before rumble strips and other safety measures were added.
"One year, I think we had four fatal accidents in two hours," he said. "Motorcycles hitting each other all the time."
However, while motorcycle accidents often get the most attention, it's the more mundane incidents that tend to preoccupy emergency personnel.
Lensegrav estimated that more than 50 percent of call-outs are related to illnesses like dehydration and chest pains.
"You have got hundreds of thousands of people all coming in your area. You get a lot of people getting sick," he said. "Plus your regular residents who need service too."
With Sturgis campgrounds already reporting that they are seeing 20 percent more patrons than last year, this year's rally is shaping up to be a big one.
What does that mean for first-responders? It means, like any other year, they'll be expecting the unexpected.
"Some days are busy," Lensegrav said. "Some days you sit there, staring at the wall."