Revellers run next to fighting bulls during the running of the bulls at the San Fermin Festival, in Pamplona, northern Spain, Sunday, July 7, 2019. Revellers from around the world flock to Pamplona every year to take part in the eight days of the running of the bulls. (AP Photo/Alvaro Barrientos)

Revellers run next to fighting bulls during the running of the bulls at the San Fermin Festival, in Pamplona, northern Spain, Sunday, July 7, 2019. Revellers from around the world flock to Pamplona every year to take part in the eight days of the running of the bulls. (AP Photo/Alvaro Barrientos)

PAMPLONA, Spain (AP) — Five people were hospitalized after the opening bull run of this year’s San Fermin festival in Pamplona, including two Americans and a Spaniard who were gored by bulls, officials in the northern Spanish city said Sunday.

A 46-year old man from San Francisco was gored in the neck in the city’s bullring, at the end of the 850-meter (930-yard) course. His injuries required surgery, the regional government reported.

A 23-year old man from Florence, Kentucky and a 40-year-old Spanish man were both gored in the thigh. Two young Spanish men sustained head injuries.

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The running of the bulls in Pamplona draws about 1 million spectators every year. During the nine-day San Fermin fiesta, six bulls are run every morning in the city’s narrow streets and then killed in afternoon bullfights.

Hundreds of “runners” race ahead of or next to the bulls, while the more risk-averse watch from balconies. Some Americans come to follow in the footsteps of Ernest Hemingway, who immortalized the Pamplona festival in his 1926 novel “The Sun Also Rises.”

The first run of this year’s festival run featured bulls from the Puerto de San Lorenzo cattle breeder.

The pack dashed together along the cobblestoned, barricaded street course. Toward the end, one of the bulls stumbled briefly, causing panic and at least one goring when it resumed the race and charged at some of the racers.

The local Red Cross said emergency personnel attended to 48 people with less serious or minor injuries, including two who were trampled by the racing bulls.

The run, which lasted 2 minutes and 41 seconds, came after the festival’s official opening — or “Chupinazo” — on Friday, when tens of thousands of party-goers shower each other with wine and champagne in a packed square.

The annual festival also includes music performances, traditional sports and dance displays, a religious procession on Sunday to honor the local patron, a firework competition and endless partying.

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Parra reported from Madrid.