PAMPLONA, Spain – The dried blood, beer, and the sticky chemical applied to the cobblestones to give the bulls’ hooves purchase have been washed clean from Pamplona’s streets for another year. The white-and-red-clad, half-buzzed tourists have gone home to New York and Los Angeles, Dallas and Topeka, Paris and Hong Kong, some nursing hangovers. A cursed few carry with them injuries that will plague them for life.
The Spanish doctors and nurses who spent the first half of July stationed along the fenced-off bull run, ready to tend to the wounded, have gone back to their day jobs in the Basque region’s hospital emergency network. They’re back to treating motorcycle accident victims instead of the horn-gored madmen who choose to run daily during the Festival of San Fermin, aka the Running of the Bulls in Pamplona, Spain, from July 6-14.
This is the story of what happens after the festival, to those who get injured—and if you run year after year, as dozens of American veteran runners have, chances are you will get hit too and suffer the consequences. This is a cautionary tale of what to do, and not to do, if you’re planning to go next year. (And it’s best to book at least 6 months out. The tiny town had 1.4 million visitors this past year, its largest crowd yet.)
The fiesta exploded…
On July 6, the fiesta “explodes” with the raucous Chupinazo, as Ernest Hemingway describes it in The Sun Also Rises. Locals and foreigners cram together in the plaza beneath city hall, dressed in white with red neckerchiefs called “pañuelos” tied around their wrists. They tote plastic bottles of cheap sangria, which they variously drink and spray on each other.
City officials gather on an ornate balcony and launch fireworks to mark the official start of the revelry. It’s all ostensibly in honor of the martyred black Christian Saint Fermin, who was beheaded in the 3rd century by a Roman governor who favored the cults of Jupiter and Mercury. Once the fireworks have gone off, the cheering crowd tie their pañuelos around their necks, and proceeds to pour throughout the town and party into the night—and some into the morning—of the first race.
In the wee hours of the morning, carpenters wall off a roughly 850-meter wooden-fenced channel running from the bull corral at the bottom, to the bull ring at the top of Pamplona’s old town, where the bullfights are held in the afternoon.
Dawn brings the start of an 8-day routine of runners heading to get on the course before 7:30 a.m. The would-be runners wait nervously, jumping in place to warm up their legs, some carrying the morning’s newspaper as per tradition, to hold it out to touch the bull. (No actual touching of the bulls is allowed, and breaking that rule will get you a sharp crack from one of the shepherd’s sticks, as shepherds accompany the bulls up the course.)
Between 2,000 to nearly 4,000 runners position themselves along the route in advance, choosing a stretch to wait for the bulls to head their way. At 8 a.m., a rocket is fired, signaling that six bulls have been set loose on the course, charging up the hill at an average speed of 24 kilometers or 15 miles per hour. They are guided by light-colored steers that run just ahead and behind them.
(Video taken by Kimberly Dozier from balcony courtesy of Northern Spain Travel.)
Like trying to catch a wave, the runners try to sprint just ahead of the bulls for a few meters before peeling off or dropping to the ground to get out of the way.
Each year, an average of 300 people get injured, with 45 runners hospitalized, city officials say. In 2018, the city reported 381 runners treated for injuries, including 42 more severely injured runners. That toll includes three Americans from New York, Miami, and Alaska respectively—who declined via city officials to be interviewed.
This was slightly less bloody than 2017, when 457 sought medical treatment along the route, including 64 who were taken to the hospital. A total of 16 people have died since 1947 when the city started keeping such records of the centuries-old festival.
To save the runners from whatever damage they’ve caused themselves, modern Pamplona has built a multilayered medical quick-reaction team. Each morning, they gather at a near-empty clinic near the bull ring, and prep their gear as if going into battle.
(Video taken by Kimberly Dozier outside the Pamplona bull ring.)
“The most dangerous Encierros [Spanish for Running of the Bulls] are when the bulls fall—when they get separated from each other, the confused, angry bulls then attack the runners,” says the festival’s chief medical officer, Dr. Kiku Betelu, as we walk through the rain to one of the main medical response areas—a cluster of ambulances parked next to a statue of Hemingway outside the bull ring.
There are more than a dozen medical stations along the route, including five more advanced trauma teams stationed along the final half of the run, from the infamous “Curve” when the cobblestone route takes a sharp right into Estafeta Street, and up the final straightaway to the entrance of the bull ring. That’s where the greatest numbers of people usually end up, funneled down a narrow road that becomes choked with panicked runners, with bulls and steers charging through the melee.
The deadliest threats runners face are the bulls’ horns, which they wield as deftly as a boxer’s fist when threatened, explained Dr. Diego Reyero, as he prepped a medical pack with saline solution, tourniquets, and tubes to intubate injured runners struggling to breathe. The last fatality in the race happened in 2009, when a bull gored a runner’s neck, nicking the carotid artery.
The wounds also tend to be dirty—from the horns, or simply from falling on the garbage-drenched stone street. The route gets power-washed in the hours just before the race, but that’s not enough to sanitize it.
The injured give up at least part of their privacy by choosing to run the race and accept medical care, as their name, nationality, age, and injury are tabulated in Spanish—and are translated into English by Chapel Hill, N.C.-transplant Lucinda Poole, one of the Pamplona city staffers helping guide the dozens of reporters who descend upon the festival along with the tourists.
“The stomach and the anal/genital area are two of the most dangerous places to be hit by the bull,” she explains with a grimace. “It happened last year.”
She keeps a running Spanish-to-English vocabulary list with terms like cerebral contusion (which is worse than a concussion), crush injury, “blunt abdominal non-penetrating injuries” and “anal fissure”—an unfortunate wound she says happens more often to American tourist runners, who often fall and try to scramble back onto their feet, as the bull is charging at them from behind.
Standing after a fall can be deadly.
“The bull’s eye is at about the level of the chest,” Poole explains as she pages through her homemade Spanish-to-English encyclopedia of bull-induced horror. “That’s why if you go down, you need to stay down. But a large percentage of the people who run have never run before. They think if they are athletic, it’s a walk in the park. It’s not.”
How to run…
You can watch explainers from American runners like Dennis Clancy on YouTube, or read books like The Bulls, an updated volume compiled by British bull runner Alexander Fiske-Harrison, with input from Hemingway’s grandson John and New York runner Joe Distler, whom Pamplona just dubbed “foreigner of the year” in this, his 50th year on the course.
“I have been gored four times, knocked out my front tooth, have two hip replacements from being hit by the bulls,” Distler says, not to gain personal glory, but to prove to Pamplona residents that they’re there for the long haul. “We are still guiris (foreigners) in the eyes of many in Pamplona and so we do all we can to show our love of the Feria (festival), its traditions and its values.”
The book’s author Fiske-Harrison has “only broken ribs” from the run, but has suffered six broken bones from training as a bullfighter. “In one, you flow with the animals. In the other, you stand, and the result can be far worse for you.”
“First rule of the run: if you go down, you stay down, hands over the back of your head,” he explained. “The bulls will see you—their eyes are angled downwards—and jump over you. Their dominant psychological drive is to keep the herd in sight, meaning they don't tread on what they don't know or trust. Also, getting up puts your stationary torso at horn height to a galloping half-ton bull,” he said, adding that this is how Matthew Tassio, the only American to die in the run, was killed in 1995.
“Otherwise keep moving, as this is a game of physics, in particular of resultant velocity. If you are hit by a horn going at 20mph when you are running it only really hits you at 5mph, and the bull, who has never seen a human on the ground before—they are ranched wild from horseback—will only seek to get you out the way, not classing you as a predator. God help you if you are stationary or moving in the opposite direction.”
The book’s photos are courtesy of the European Pressphoto Agency’s Jim Hollander, who switched from running to snapping photos of the race and the bull fights after a particularly brutal encounter with two bulls in 1977.
His last official run started to go wrong when a white steer spotted him near the entrance to the bullring.
“The steer came right at me full-force, and he put his horn between my legs and flipped his head up. I did a triple somersault,” Hollander explains. “When I landed on the ground, there were two Miura bulls right behind the right steer.” (The Miura breed is known for its ferocity in the bull ring.) “The two bulls saw me fall from the sky in front of them, and they came at me—one lowered his head to hit me but missed, so instead it tripped and fell on top of me, and there was another bull behind him who came for me too.
“I got kicked around a lot. I didn’t get up, so I didn’t get gored. If I had gotten up, I probably would have gotten a horn under my armpit,” Hollander said, the detail of the day etched into his brain by the terror of being manhandled by thousands of pounds of charging fury.
He said a friend running nearby that day had it worse. “A bull’s horn nicked his scrotum. He was almost killed.”
The worst he’d ever seen? That fatal goring of 22-year-old American Matthew Tassio in 1995. Tassio stood up to flee after being knocked down by the bulls. “The bull saw him and just lowered his head and horn,” and hit the Glen Ellyn, Illinois, native at a full gallop. “Very hard to watch on TV replays. If he’d stayed down, he wouldn’t have gotten hurt.”
Do as I say, not as I…
“My first advice to anyone who wants to run is, ‘Don’t do it. It’s too dangerous. You’re going to get hurt, you might get killed,’” said Chicago runner Bill Hillmann, 36. “If I can’t talk them out of it, I’ll give them advice—the obvious spots you should avoid running… and if you fall down, stay down.”
Hillmann says you can be maimed for life even if you follow the course rules, both the formal and informal: don’t be drunk; don’t tie your sash in a knot or wear your red fiesta neckerchief/pañuelo at all, as the bull’s horns can hook them and drag or strangle you; don’t carry *anything* especially a selfie stick (which would be confiscated if the cops patrolling the course ahead of the race see it); wear comfortable footwear; have multiple escape strategies; don’t wave your arms or draw attention to yourself—and consider not running on the weekend when it’s more crowded.
Hillmann followed those rules, but he still got gored in 2014, just ahead of publication of his book Mozos, a Decade of Running with the Bulls of Spain. His publisher had wanted to call it, “How not to get gored,” but he’d refused, saying that he knew that “eventually” he would get gored.
Hillmann blames the bloody incident on panicked tourists who pushed him into the path of a bull that had separated from the herd, known as a “suelto.”
“Everything was going good, but some tourists who were panicking, they freaked out. We collided, and they pushed me down in front of the bull and the bull gored me in the leg, and gored me again under the knee,” he recounted matter-of-factly. “That wound was huge, like the size of a racquetball, 9 inches deep, the other one was a little smaller, but I still got a big scar from it. These things happen.”
What annoys some town officials is that Hillmann is taking a calculated risk at their expense. He makes his living in part from writing about the bull run—or via his new vlog/podcast, Red, White & Bulls—and he fully expects to get hurt, but when he was hurt in 2014, he had no medical coverage.
“I was broke, I didn’t have money for insurance,” he said in an interview with The Daily Beast. “Other runners came and supported me, saying I shouldn’t have to pay, so there was a lot of negotiation, and it got ‘taken care of.’” City officials declined to comment on whether they ultimately picked up the bill, but the way Hillmann sees it, they’re making enough money out of runners like him that they can afford it.
“When you make a dangerous event like this free and open to the public, it seems you should expect some expenses, like treating people who almost die doing it,” he said by email after the fiesta. “Pamplona City Hall makes half a billion dollars or more every year during fiesta from taxes, from tourist money… I feel like medical care is a human right.”
If he had gotten hurt during this fiesta, he’d planned to rely on his Illinois-based Medicaid provider for treatment.
That might conceivably work if he could get himself back to Chicago for care, because Medicaid providers don’t have to report the nature of the injury, according to Illinois’ Medicaid spokesman John Hoffman. But Medicaid would not pay for the overseas bill from the Navarran hospital, however. “Federal law prohibits payment to institutions or entities located outside of the United States,” Hoffman emailed.
Hillmann said he was unaware of that, and would buy health insurance for next year’s run, if he could afford it.
“Most policies cover accidental injury, which is what this is,” said Michael Sullivan, spokesman for CareFirst BlueCross & BlueShield in the Washington, D.C. area. “There might be some out-of-area limits. Your policy might not cover transport back to your home.”
He also cautions that employer-provided insurance might be more restrictive, so he recommends that groan-inducting adulting task: read the policy before traveling.
Other medical insurers including Aetna and Kaiser Permanente declined to detail what their policy would be, with the frequent refrain that it would depend on an individual’s chosen coverage plan.
For those who can’t pay? “I’m not too concerned,” one Pamplona parliamentarian told The Daily Beast with a shrug, as she visited the medical teams ahead of one of the morning’s run. “It’s not going to break our budget.”
We can rebuild him…
Hillman was on hand when another American runner got hurt last year.
Jack, as we’ll call him, didn’t really feel it at the time.
“On this particular morning, a bull closed my right exit so I went to my left and the other bull came up to my left and hit me,” he explained over a Kaiku and Cognac—the breakfast drink of the bull-running champions that frequent Ernest Hemingway’s old hangout Bar Txoko. “His head hit the bottom of my elbow, and drove the bone through, shattered the radial head of my shoulder, and it was broken before I hit the ground. It was like getting hit by a car at 22 miles an hour.”
“Now I have a titanium plate, 9 screws, and 24 inches of Kevlar suturing in there, for life,” Jack explained, raising a shirt sleeve to show the puckered scar. He hadn’t felt it right away, with shock blanketing his nervous system, but he saw his clothing was torn, so he went to the Red Cross medics to get checked out.
“I actually didn’t feel any pain in my shoulder. I was more concerned about my knee and the back of my right leg because my pants had been torn. Typically, if your clothing is torn, it’s torn by either a horn or a hoof, one or the other,” he explained. “So my biggest fear is that it was a horn and I’d been gored in the leg, because you can’t feel it because of the adrenaline.
“So I asked a fellow runner to check out my leg, and he said you’re good, there’s no holes, and I said OK, I’m going to go to the medics and get checked out, and get my wounds cleaned up, because you never want to let any wounds that you get on the street fester... The streets are quite dirty. So they cleaned me up… they did a thorough check for goring, right up my underwear, and said ‘Okay, you’re good.’”
Then he asked the team to check his shoulder because it felt “weird.” A senior medic asked him to move it a couple different ways, and he couldn’t.
But he refused to get in the ambulance from the course, instead taking a taxi to the clinic in town for an X-ray. A Basque runner he’d befriended only that year went with him, as Jack’s Spanish wasn’t quite up to understanding complex medical briefings—Navarran hospitality at its finest. They’re fast friends to this day.
The clinic sent Jack straight to the hospital after confirming the damage, where doctors wrapped up his shoulder and told him he needed reconstructive surgery—but could get it done back home.
His wife Victoria remembers that day a little differently. She knew what she was getting into. Jack had brought her to the festival before asking her to marry him. He had to make sure she could stomach his “Hemingway habit,” which is as much about the camaraderie of this wonderfully oddball crew of individuals coming back, year after year, as it is about the stomach-churning prospect of that 8 a.m. daily dash with the bulls. Now he’s been to a total of 11, and she’s attended 8.
So, as was her habit, she’d been in their rented Pamplona apartment, watching the morning race on TV. It’s simulcast across Spain like any major sports event, with cameras including one on a wire above the course that catches every frame—and just about every fall.
Watching the Encierro in simulcast technicolor, she saw Jack go down.
“I’ve seen him fall before, and it’s been fine. And so I saw him try to go right, and I saw him try to go left, and I saw him get hit.” She screamed, there alone in the apartment, and rushed to their meeting spot—Bar Txoko.
“And he wasn’t coming, and he wasn’t coming.” So she sent out friends searching for him, and Hillmann appeared, and said come this way, gripping her tightly around the waist as he walked her to one of the emergency stations just off the course. “I was thinking, this isn’t good, this isn’t good, and I can’t ask because I was scared to ask.”
But as soon as they turned the corner, she saw her husband standing next to the ambulance.
“He was looking at me, and had this grin on his face like ‘Hey, it’s OK.’ I thought, he’s alive. Whatever it is, we’ll be fine.” She spent August feeding him medicines every two hours and taking him to rehab.
Jack says his shoulder is back to about 85 percent function, after a $5,000 deductible and $95,000 worth of reconstructive surgery. “The doctor said it will take 12 to 18 months to 95-98 percent,” he said. “It will never be a 100 percent because of the extent of the injury.” He shrugged, happy to have gotten off relatively easy.
This correspondent spotted Jack running this year, into the bull ring just after the shot went off declaring the start of the race—in other words, way ahead of the bulls with almost no chance of encountering them, a practice called running “valiente,” or brave, meaning not brave at all.
“I promised my wife that’s how I’d do it this year,” he explained sheepishly at Bar Txoko later, during the usual post-run morning gathering.
Next year? He’s won’t say.
American lawyer and bull runner Peter Milligan was injured in 2015, the same year his book, Bulls Before Breakfast was published—indeed, he was injured at almost the exact time his book was published, which begs the question as to whether it’s wise to write books about bull-running. (Hemingway is rumored to never have run, but did get knocked around while playing amateur bullfighter with young bulls in the ring, which happens at the end of each day’s run.)
Be that as it may, Milligan was running into the bullring when his feet got twisted under another runner in the crowd cramming through the narrow opening.
“Didn’t even think I was hurt, and then saw blood on my leg,” he recounts over some breakfast rosé. “It was a compound fracture, two bones sticking out of my ankle. I couldn’t stand up. There were still bulls coming, and a member of the Red Cross, an older lady, jumped over the railing and physically covered me with her body and helped get me to safety.”
“My first thought was, do you think I’ll be able to make lunch? Because I’ve got lunch reservations at 2 p.m.”
He spent five days in the hospital, tucked away in the maternity ward, because there were so many injuries that year. He became a minor celebrity. “Everybody was having their babies and bringing them to meet me. Meet the American runner!”
He wanted to go home but the broken bones were too close to arteries. The surgery was complex—but perfect, according to Milligan’s orthopedic surgeon when he got home to Cherry Hill, N.J. The bill was only $7,000 for five full days in the hospital, which his insurance back home paid.
One problem? He had to get a skin graft, because Spain still uses plaster casts, and this one didn’t get put on quite right.
“I got a plaster cast up to my waist, and the muslin slipped in the back, and I got a chemical burn. So I had to have a skin graft on the back of my leg when I got home, and that ended up being the worst thing,” he said.
The other downside? No champagne or flowers from the Spanish king, like his brother Ari got when he was injured running with the bulls in 2014.
“He got gored, and was asked, will you run again? He said, ‘Unless they have to amputate my leg, I’m running tomorrow.’” That snippet of his brother’s interview went viral. “We get back to our hotel room, and I thought somebody was pranking us, and there was flowers and champagne from the king of Spain. Next year, I get hurt, and what do I get? Nothing!”
There’s always next year.