The Running of the Bulls (Encierro in spanish) is held during 8 days in the Saint Fermin festival in Pamplona,
Spain (Fig. 1,
Fig. 2).
It’s a practice that involves running in front of a group of six Spanish fighting bulls (toro de lidia) and six steers,
on a course of a sectioned-off subset of the town's streets.
A set of wooden fences are erected to direct the bulls along the route and to block off side streets.
The length of the run is 875 meters (Fig. 3). Although this is a relatively short distance,
it is impossible for a runner to cover the whole course,
because of the presence of so many other runners and above all,
the enormous speed of the bulls.
This event takes place each morning among the 7th and the 14th of July,
at 8 o’clock in the morning.
Usually,
the run should just take between 2 to 3 minutes to complete,
although the longest took 30 minutes in 1958.
Participation is completely free and any person who is 18 years of age or over may take part.
However,
there are a series of norms and rules that need to be respected.
The city police is strict,
particularly in ensuring that no drunk or intoxicated runners are admitted into the course of the run.
About 2,000 people participate in each Running of the Bulls.
Occasionally,
there are serious gorings and injuries,
especially when a bull gets separated from the pack or when occurs a pile-up.
Although it is rare to have a death occur,
sixteen people have died since 1910, two of them in this century (Fig. 4).
Medical attention
All the runners in the Running of the Bulls event are guaranteed to receive all the medical treatment they might need in case of injury.
To minimize the impact of injuries,
every day over 200 people collaborate in the medical attention.
They are deployed in 16 sanitary posts (every 50 metres on average),
each one with at least a physician and a nurse among their personnel.
In addition to the medical posts,
there are around 20 ambulances.
This organization makes it possible to have a gored person stabilized and taken to a hospital in less than 10 minutes.
Every year from 100 to 300 runners are attended in the sanitary post,
of whom 97% have mild injuries.
Also,
there is a medical facility in the bullring with an operating room,
and a team of physicians,
including a general and a trauma surgeon,
an anesthesiologist and a radiologist,
who has to perform ultrasounds in case of need.
Not all of the injuries require taking the patients to the hospital: in 2017,
51 people were taken by ambulance to “Hospital de Navarra”,
and 63 in 2016.
An average of 10 patients are admitted to the hospital.
The most common injury is limb trauma,
specially in lower extremities,
followed by head injuries.
The bull horn injuries are not the most common,
but probably are the most impressive,
and their most common location is in the back of the high (specially the left one).
Other common injuries are provoked by stomps (either from bull or other runners).
And finally,
the pileups are the least common cause of injuries,
but they are very dangerous when occur.
Practically all of the patients,
who need attention in the emergency department,
had a radiological exam at admission,
being the plain radiographs the more common.
The second more common imaging technique performed was the CT scan,
which is probably preferred over the ultrasound (US) because these are usually patients with high energy trauma.
The US is reserved to patients with low pretest probability of having a serious condition,
or to unstable patients who had a FAST ultrasound in the resuscitation room.
We reviewed all the patients who had a diagnostic CT scan in the last 7 years (2011-2017),
which are.
An average of 18 patients a year needed a CT scan in the emergency department.
We made a pictorial review of the more interesting cases during these years,
and also from previous years that we were able to recover ( Fig. 5 ).