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The reported increase in traumatic injuries at the US-Mexico border from wall falls after the height increase to 30 feet in 2018 has been limited to adults triaged to a level 1 trauma center.^1-3 Border wall fall encounters at an open-air detention site (OADS) near the San Ysidro-Tijuana border have become common.⁴ We seek to characterize these prehospital border wall fall injuries.

This was a cross-sectional study of first-aid migrant encounters at an OADS west of the San Ysidro port of entry, where dozens to hundreds await Customs and Border Protection (CBP) processing daily. Children were recently ruled to be in CBP custody at this location without formal medical support or triaging protocols.⁴ Encounters, documented by medical and nonmedical volunteers, were reviewed by a physician and selected if they presented between October 1, 2023, and January 31, 2024, after a border wall fall. Demographics included age, sex, and country of origin. Primary signs and symptoms were collected and used to categorize suspected injuries into anatomical regions defined by the Abbreviated Injury Scale (AIS).⁵ The primary outcome of interest was emergency medical services (EMS) activation and health care facility transport at the discretion of CBP. Treatment received was defined as bandaging, wrapping, or over the counter analgesics. This study was approved by the University of California, San Diego institutional review board, with informed consent requirements waived due to the deidentified nature of the data.

Descriptive statistics for total and pediatric (under age 18 years) populations were performed. Univariable comparisons of demographics and injury characteristics were made between patients with EMS activation to those without. Categorical variables were compared using Pearson χ² or Fisher exact tests. Continuous variables were compared by independent samples t test or Wilcoxon rank-sum tests for parametric or nonparametric distributions, respectively. Statistical analysis was completed using R version 4.3.1 (R Core Team). We followed the Strengthening the Reporting of Observational Studies in Epidemiology () reporting guidelines.

A total of 95 individuals were included. The most common known country of origin was Colombia (22 individuals [23%]). Mean (SD) age was 27 (13) years (46 female [58%]). The most common presenting signs and symptoms were musculoskeletal pain (57 individuals [60%]) and abrasions or burns (26 individuals [27%]). The most common suspected injury location was lower extremity (38 individuals [40%]). A total of 22 individuals (23%) had EMS activated. Of 11 pediatric cases (12%), suspected head injury was most common (5 individuals [45%]) and 5 (45%) had EMS activated (Table 1). Patients with EMS activation more often presented with suspected head injuries (7 of 22 [32%] vs 3 of 73 [4%]; P < .001) and less often with external injuries (0 of 22 vs 23 of 73 [32%]; P = .002). They also received treatment at lower rates with bandaging or wrapping (1 of 22 [5%] vs 26 of 73 [36%]; P = .005) or analgesics (2 of 22 [9%] vs 28 of 73 [38%]; P = .01) (Table 2).

Compared with the 67 border wall injury admissions to UC San Diego Level 1 Trauma Center in the 3 years (2016-2018) prior to the height increase, there were 22 individuals with health care facility transport over the 4 months in this study.² Pediatric cases comprised half of suspected head injuries, aligning with the increased incidence in adults.¹ Individuals with loss of consciousness, extremity weakness, and/or suspected spine injuries were not more likely to have EMS activation and less than 25% had EMS activation for treatment overall. Because these falls occurred from 18 to 30 feet, these migrants were at least at moderate risk for serious injury per national trauma triaging protocols.⁶

This study suggests that the magnitude of border wall fall injuries is greater than prior reports and illustrates potential to improve prehospital medical triaging, such as routine medical surveillance. Limitations include potential for selection bias as cases were documented by volunteers and triaged by CBP. Therefore, it is unlikely all incidents were captured and possibly biased toward severe cases, undercounting the injury burden. Additionally, there is no comparison group of prehospital injuries prior to the height increase.

Accepted for Publication: July 31, 2024.

Published: October 4, 2024. doi:10.1001/jamanetworkopen.2024.37244

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 Tenorio A et al. ÌÇÐÄvlog Open.

Corresponding Author: Alexander Tenorio, MD, Department of Neurological Surgery, University of California, San Diego, 9300 Campus Point Dr, MC 7893, La Jolla, CA 92037 (atenorio@health.ucsd.edu).

Author Contributions: Dr Tenorio had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Tenorio, Greenblatt, Doucet, Levy.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Tenorio, Schecter, Greenblatt.

Critical review of the manuscript for important intellectual content: Tenorio, Greenblatt, Young, Hill, Doucet, Levy.

Statistical analysis: Schecter.

Administrative, technical, or material support: Tenorio, Doucet, Levy.

Supervision: Tenorio, Greenblatt, Young, Doucet, Levy.

Conflict of Interest Disclosures: None reported.

Data Sharing Statement: See the Supplement.

Additional Contributions: We thank University of California, San Diego medical students Eli M. Solomon, BA, Lauren S. Ibarra, BS, and Carson P. McCann, BS for data collection and statistical support. We thank Ovanes Abramyan, PA-S, MPH in affiliation with Al Otro Lado for statistical support. We also express deep gratitude to humanitarian, first-aid, and community volunteers who have been providing critical support to migrants at the US-Mexico border including American Friends Service Committee, Al Otro Lado, Southern Border Communities Coalition, Survivors of Torture, and Border Kindness amongst others. None of the above-mentioned individuals received compensation for their contributions to this report.