A 46-year-old San Francisco man and a 23-year-old Kentucky man joined ten others injured by bulls in this year’s San Fermin festival.

The festival draws multitudes of tourists each year. Some of them leave on stretchers. This year, two of those were traveling Americans.

While neither has been identified, both are said to be in “serious” condition. The younger Kentucky man was gored in his left thigh, while the San Francisco native was gored in the neck on Sunday during the festival’s opening bull run. A witness said both attacks occurred “right close together, and very fast.”

Others injured include onlookers being thrown, gored, and receiving head wounds. The six bulls responsible for the injuries were raised at Cebada Gago ranch, known for the cultivated hostility of its livestock. Red Cross spokesman José Aldaba said that some of the victims were treated immediately at the region’s primary hospital. Only one did not require hospitalization.

Despite the typically bloody nature of the runs, the festival’s momentum has not slowed. Six more runs will be held over the course of the week. The bulls are run during the “encierros” early in the morning, then tortured to death in the afternoon’s bullfights. Each year, hundreds of people are injured during the festivities.

There have been 16 deaths officially recorded during the running of the bulls since the recording of casualties began in 1910. The most recent death was in 2009 when a Madrid man was gored in the neck. Only time will tell whether 2019 will add to that bloody tally.