SAN DIEGO — San Diego sits at the heart of a growing humanitarian and healthcare crisis – one that plays out daily at the U.S.-Mexico border. In her powerful presentation at the NAEMSP Grand Rounds, Dr. Amanda Humphries, an experienced trauma surgeon and global health advocate, walked attendees through the stark realities faced by migrants crossing the border, and the EMS providers and hospitals that care for them.
Her message was clear: migration isn’t stopping, but the cost – in injuries, lives and healthcare resources – is rising sharply, fueled by desperation and dangerous barriers, like the towering 30-foot border wall.
The border’s impact: A frontline perspective
From her vantage point at a trauma center just 20 miles from the San Ysidro Port of Entry - the busiest land crossing in the Western Hemisphere – Dr. Humphries and her team see the human toll of migration daily.
Each night, EMS crews and hospitals care for migrants injured trying to scale the wall, only to fall from heights that produce devastating injuries. The physical, emotional and logistical challenges of managing these cases ripple through the healthcare system, leaving frontline providers to address the fallout of a complex global crisis.
The evolution of the U.S.-Mexico border wall has directly contributed to a surge in life-altering injuries. Over the past three decades, the wall has grown taller and more formidable. Under recent policies, sections of the wall now stand at an imposing 30 feet – nearly three times the height of earlier iterations.
The increase in wall height has brought with it a new epidemic: high-velocity trauma from falls. Migrants, determined to cross despite the dangers, use makeshift ladders or ropes to scale the wall, often falling from the top.
| More: Digital Edition: Prehospital trauma: Today’s tenets for triage, treatment and transport
Dr. Humphries shared sobering details EMS encounters:
- Lower extremity fractures: Most patients land on their feet, resulting in shattered calcaneus (heel) bones, tibias and ankles. These are not simple fractures – many are so severe that patients will never walk or work again.
- Spinal injuries: The force of impact frequently causes thoracolumbar fractures, many requiring complex surgeries. Nearly 10% of these injuries include nerve damage or paralysis.
- Traumatic brain injuries (TBI): Those who fail to land on their feet often suffer skull fractures, subdural hemorrhages or diffuse brain injuries, leading to long-term neurological deficits.
“These injuries aren’t just disabling – they’re life-changing,” Dr. Humphries explained. “Patients who crossed to build better futures are now left unable to walk, work or care for their families.”
An overwhelmed EMS and healthcare system
For EMS providers, managing these cases begins in some of the most challenging environments imaginable – remote desert areas, dense brush or riverside crossings. Responders navigate language barriers, critical injuries and coordination with Border Patrol, often under immense pressure.
Once patients reach hospitals, the impact deepens. Dr. Humphries’ trauma center has seen a staggering increase in border-related trauma cases:
- In 2019, fewer than 100 patients were admitted for border-related falls.
- By 2024, this number had skyrocketed to over 700 annually.
- These patients now account for 20% of all trauma admissions at her hospital.
- Operating rooms are overbooked, ICU beds are scarce and case managers struggle to coordinate follow-up care for patients who often leave the area after discharge.
The financial toll is equally daunting. In California, emergency Medicaid helps offset costs, though the Medicaid reimbursement for an ambulance journey does not cover the cost of readiness. Hospitals in other states, like Arizona, however, face funding gaps that threaten their financial stability. Dr. Humphries reported that her center’s costs for treating border injuries ballooned from $11 million before 2020 to over $72 million in just 3 years.
The human faces behind the numbers
Dr. Humphries shared poignant stories to underscore the desperation driving migrants to risk their lives.
One woman from Nicaragua journeyed 3,000 kilometers with her children, enduring unimaginable hardship, only to fall from the wall in the final stretch. Asked why she risked her life, she responded, “I had already come so far. I couldn’t stop at the wall.”
Language barriers further complicate care. While many patients speak Spanish, others speak Somali, Punjabi or dialects for which interpreters are nearly impossible to find. EMS crews and hospital staff often struggle to communicate, heightening the stress for both providers and patients.
Orthopedic trauma: A new epidemic
The orthopedic injuries sustained in border falls are unlike anything most trauma centers typically encounter. Bilateral calcaneal fractures – a rare and debilitating injury – are now routine at Dr. Humphries’ facility.
“This injury is catastrophic,” Dr. Humphries explained. “These patients will live with chronic pain, limited mobility and permanent disability. It’s heartbreaking to know they crossed seeking opportunity but will leave unable to work or support their families.”
In a recent study at her hospital:
- 86% of patients with orthopedic injuries were discharged non-weight bearing – unable to walk or bear weight on at least one extremity.
- 80% lacked access to follow-up care, leaving injuries untreated and recovery incomplete.
- Patients discharged with external fixation devices or casts often travel by bus across the country, far from any medical supervision.
Dr. Humphries highlighted the global forces driving migration – war, poverty, climate change and violence. The U.S.-Mexico border is just one part of a worldwide crisis, but for EMS providers and healthcare workers in Southern California, its impact is inescapable.
Despite the challenges, Dr. Humphries and her team are committed to documenting the injuries and their consequences. By publishing research and testifying before Congress, they hope to bring objective data to the forefront of policy discussions.
“Building a higher wall doesn’t stop migration – it just creates more injuries,” Dr. Humphries concluded. “The people who come here are seeking hope and opportunity. It’s up to us to provide the care they need and to advocate for solutions that reduce harm.”
For EMS professionals, this session served as a powerful reminder of the human stories behind the statistics and the critical role they play in responding to this complex and evolving crisis.
