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Study finds falls from new, higher border wall causing complex fractures, hospital crowding, death

The falls caused 16 deaths and five times more admissions to San Diego trauma center already overloaded by COVID-19. Injuries included complex facial, pelvis and leg fractures. Patients included children and pregnant women.

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A new section of border wall constructed in a remote expanse of desert outside Yuma, Arizona, under the Trump administration. Replacing the previous 6-to-17-foot border wall with a 30-foot barrier at the southern U.S. border was followed by a five-fold increase in wall-fall hospitalizations at a nearby level 1 trauma center in San Diego, according to a new study published in the journal JAMA Surgery.
Molly O'Toole / TNS
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ROCHESTER, Minn. — Replacing the previous 6-to-17-foot border wall with a 30-foot barrier at the southern U.S. border was followed by a five-fold increase in wall-fall hospitalizations at a nearby level 1 trauma center in San Diego.

That is the finding of a study published April 29 in the journal JAMA Surgery .

The study found that with the higher fence — erected after a 2017 executive order from President Donald Trump — came millions in new medical expenses for the hospital and the expansion of a trauma unit to accommodate more patients for longer stays.

The study also noted "a new phenomenon" closely tied to the arrival of the wall: "the appearance of scene deaths," or fall-related fatalities at the base of the structure. It reported 14 such deaths during the period studied, joined by two other deaths recorded in the ER.

"Raising the U.S. border wall to 30 feet is associated with increased deaths, increased injury severity score, and increased health care costs," the authors of the research letter wrote. "It increased the burden of complex injured patients at a level 1 trauma center already dealing with a traumatic surge and respiratory surge during the COVID-19 pandemic."

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Dr. Amy Liepert is the medical director of acute care surgery at the University of California, San Diego, and a coauthor of the study. She said the impetus for the study was that "whenever we start to see something happening clinically, we try to verify what we think we're seeing with the data."

"We were finding that more of our calls were being occupied with injuries in the border wall, and we were also finding that the injuries were more severe," Liepert said in an interview.

In response, Liepert and six colleagues carried out a retrospective comparison of hospital admissions at their medical center serving the southern border in California, assessing wall-related falls during two-year periods before and after the new barrier went up in 2019.

These are fractures not like you get from falling off your bike or tripping on the ground. These are bones broken in multiple places, sometimes coming through the skin.
Dr. Amy Liepert

To control for any increase in crossing attempts, the researchers calculated the rate of injuries treated per 100,000 immigrant apprehensions by Customs and Border Protection agents. There were just over 159,000 apprehensions in San Diego and Imperial counties during each of the periods studied.

Following the construction of the new wall, admissions for falls jumped five-fold, from 67 to 375 severely injured patients. The study further noted that the average injury severity score of these admissions jumped by 25%, the average length-of-stay jumped from four to six days, and that the average ICU visit jumped from a half day to two days.

Following adjustment for inflation, hospital costs for these visits jumped from $31,000 to $45,000, on average.

Liepert says that while they did not quantify the demographics of those who were injured, the hospital has seen children and pregnant women who needed care.

"We see a whole range of injuries," Liepert said, "the most severe of which are traumatic brain injuries ... More commonly we will see very complex fractures of the legs particularly, but sometimes the arms."

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"These are fractures not like you get from falling off your bike or tripping on the ground," she said. "These are bones broken in multiple places, sometimes coming through the skin."

Liepert noted "facial fractures, rib fractures, pelvis fractures, other significant injuries," calling them "complex fractures that require multiple operations, often with external fixation devices, before a definitive operation or repair can even be done."

Liepert says that as an observation the injuries led to higher stress on doctors and the hospital, which had to expand into unused rooms to add more trauma beds.

"Clearly when there's more work to be done and we have the same amount of staff to do it ... That means there's longer wait lists, because more cases have to be done in a finite period of time."

The authors wrote that future border barrier policy decisions "should include assessment of the impact of increased injuries on local health care systems."

"We need to have the resources and the support," Liepert says, "however the policy is decided, to expand services as necessary if this type of injury continues to occur at these rates."

Paul John Scott is the health correspondent for NewsMD and the Forum News Service. He is a novelist and was an award winning magazine journalist for 15 years prior to joining the FNS in 2019.
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