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Case Reports

Wall Falls

Blunt Trauma Sustained from Border Wall Crossings

Jackson, Nicole R. MD, MPH; Lathrop, Sarah DVM, PhD; Dvorscak, Lauren MD

Author Information
The American Journal of Forensic Medicine and Pathology: September 2021 - Volume 42 - Issue 3 - p 243-247
doi: 10.1097/PAF.0000000000000674
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Abstract

Originally constructed in the early 1990s, the Mexico–United States barrier, known as the border wall, serves as a deterrent to illegal immigration, drug smuggling, and human trafficking between the 2 countries.1 This wall consists of a discontinuous series of varied physical walls alternating with areas of virtual fencing along the nearly 2000 miles of land between the southern tip of Texas in the Gulf of Mexico and the Pacific Ocean separating the 2 countries.2 (Fig. 1) It is surveilled by Border Patrol Officers under the Department of Homeland Security’s US Customs and Border Protection, implementing tools that include infrared night vision scopes, seismic sensors, drones to tethered aerostat balloons, motion-sensor cameras, and helicopter patrols.3 An estimated 990 immigrants died between 2017 and 2019 along the United States–Mexico border.4 The border wall has recently garnered increased attention due to the discussion of federal expansion.

FIGURE 1
FIGURE 1:
The Mexico–United States barrier with planned wall expansion. A, Depicted is the Mexico–United States border, which runs from the Gulf of Mexico at the tip of Southern Texas on its eastern end to the Pacific Ocean on the west. Dark blue segments represent approximately 700 miles of existing barriers, whereas red segments represent the new border wall system proposed in 2019. B, A closer view of the New Mexico–Mexico border depicts significant planned expansion as part of the El Paso Border Wall System Project. C, Wall replacement and expansion efforts consist of reconstructing old segments of the wall and extending them using steel and concrete.

New Mexico is one of 4 states bordering Mexico, neighboring the Mexican states of Chihuahua and Sonora. It falls under the El Paso Sector of the US Border Patrol, which also provides law enforcement support to the Texan counties of El Paso and Hudspeth and which recorded 32 deaths between 2017 and 2019 related to the border wall.5,6 Before 2017, the portion of the border wall in New Mexico was relatively short; however, construction has begun on this small segment, which is planned to increase to a large majority of the state’s southern border, likely increasing deaths related to accidental falls from people scaling the wall7 (Fig. 1).

The New Mexico Office of the Medical Investigator investigates such unnatural deaths at its centralized, statewide office located in Albuquerque, New Mexico. Two cases of fatal blunt force trauma sustained from attempts at crossing the physical portion of the border wall into the state of New Mexico are described. Injuries sustained from these falls are compared with those sustained from ground-level and great heights, as well as how these are expected to change with the anticipated expansion of the wall.

MATERIALS AND METHODS

The Office of the Medical Investigator's electronic database was queried for all deaths occurring in New Mexico's “international zone” between January 1, 2017, and March 31, 2020. The international zone was defined as the 3 counties adjacent to Mexico: Hidalgo, Luna, and Dona Ana. Data were then cleaned in Excel based on inclusion and exclusion criteria. Inclusion criteria consisted of decedents with border wall–related blunt trauma. Excluded from the analysis were deaths from other means. A review of the full Death Investigation Summary was performed to ensure proper inclusion in the study. The Death Investigation Summary consists of the following sections: Declaration, Summary and Opinion, External Examination, Medical Intervention, Postmortem Changes, Evidence of Injury, Internal Examination, Microscopy, Postmortem computed tomography (PMCT), and Procedural Notes.

Using a Philips Brilliance Big Bore 16 Slice computed tomography scanner with an 85-cm bore, a flat bariatric table, and Big Bore version 4.2 software, PMCT was used to help identify injuries before the autopsy examination. A full autopsy examination was performed by a forensic pathology fellow under the supervision of a board-certified forensic pathologist. The vitreous fluid was collected at the start of the autopsy for potential analysis for abnormalities, particularly pertaining to dehydration. Toxicological testing of the postmortem blood collected at autopsy was performed to detect ethanol and commonly abused illicit, prescription, and over-the-counter medications at National Medical Services Labs.

RESULTS

From January 1, 2017, to March 31, 2020, 439 decedents were brought to the Office of the Medical Investigator, who died within the international zone. Of these, 2 were determined to die of injuries sustained from falling from the border wall, each occurring near an 18-ft-high segment.

Case 1

In response to the sounding of sensor alarms one spring night, a Border Patrol officer searched his patrol area and discovered the body of a 26-year-old man located in the supine position on the dirt road running parallel to the border wall (Fig. 2). Law enforcement was notified, but resuscitation was not attempted due to obvious demise. This section of the wall consisted of 18-ft-high steel poles spaced approximately 1 ft apart and with horizontal sheets of steel positioned at the top.

FIGURE 2
FIGURE 2:
A young man found dead next to the border wall with significant blunt force trauma of the chest. A, The decedent's body, as found at night near the wall. B, Focal hemorrhage of the apex of the right lung centered in an area with air trapping. C, An axial PMCT scan demonstrating bilateral pneumothoraces (right greater than left) with moderate atelectasis of the right lung, rib fractures, and scant air trapped within the chest wall. D, A more caudal axial PMCT scan demonstrating more extensive pneumomediastinum with bilateral pneumothoraces.

Postmortem computed tomography detected bilateral pneumothoraces (right greater than left), pneumomediastinum, and subcutaneous emphysema of the right chest wall (Fig. 2). Evidence of injury of the extremities consisted of fractures of the distal portions of the left tibia and left fibula. There was no evidence of injury to the head or neck.

A complete autopsy examination revealed a well-developed young man with additional injuries consisting of superficial blunt trauma including left periorbital ecchymosis, a small laceration inferior to the left eye, scleral and palpebral hemorrhages of the left eye, and scattered abrasions, lacerations, and contusions of the chest, right hip, back, and extremities. Aside from focal right lung apical hemorrhage in an area of emphysema, neither organ nor vascular injury was identified, and there were no additional fractures (Fig. 2).

Natural disease consisted of mild atherosclerotic cardiovascular disease. Nonspecific findings associated with death included mild cerebral edema (brain, 1475 g) and moderate pulmonary edema (combined lung weight, 1170 g). Analysis of the vitreous humor revealed no evidence of dehydration and was in keeping with a postmortem sample. Toxicological testing of the postmortem femoral blood was negative.

Given the superficial injuries and nonlethal bony trauma, death was ascribed to tension pneumothoraces. The cause of death was certified as blunt trauma, and the manner as an accident.

Case 2

During one early autumn night, in response to the tripping of border wall sensors, a Border Patrol officer discovered the body of a 55-year-old woman located on the ground 18 in away from an area of the wall lacking lighting (Fig. 3). This section of the wall consisted of an 18-ft-tall steel paneled fence consisting of a series of parallel, vertical poles stationed approximately 6 in apart. The top 3 ft of the fence had steel metal plates secured to the vertical poles to make the top portion solid. The vertical poles were hexagonal to decrease gripping with the hands and diagonal on the top to form a slant to decrease foot stability should they be scaled. The decedent had been traveling with 2 other individuals who were detained and questioned. Per the detainees, she had been traveling with their party when they climbed the fence and crossed the wall. As she was located behind them, they did not know she had fallen.

FIGURE 3
FIGURE 3:
A middle-aged woman found dead on the New Mexico side of the United States–Mexico barrier at night. A, The decedent's body, as found in the middle of the night near an unlit stretch of the 18-ft-high wall. B, An axial PMCT scan reveals hemopericardium and small, bilateral hemothoraces. C, Upon removal of the breastplate, laceration of the heart and lungs from blunt force chest trauma is seen. D, Basilar skull fractures are seen after removal of the brain and stripping of the dura mater.

Postmortem computed tomography detected soft tissue hemorrhage of the left side of the face and scalp, intracranial hemorrhage, minimal pneumocephalus with an associated basilar skull fracture, left clavicular fracture, hemopericardium, left greater than right anterior and posterior rib fractures with variable displacement and trace pneumothoraces, and bilateral hemothoraces (Fig. 3).

A complete autopsy examination revealed a well-developed woman with additional trauma consisting of periorbital ecchymosis; subscalpular and subgaleal hemorrhage; subarachnoid hemorrhage; lacerations of the heart, lungs, and liver; and scattered abrasions and lacerations of the head, trunk, and extremities. The abnormal fluid collections identified by PMCT were quantified as follows: hemopericardium, 120 mL; right hemothorax, 100 mL; and left hemothorax, 50 mL (Fig. 3).

Natural diseases included mild atherosclerotic cardiovascular disease, uterine leiomyomata, and colonic diverticuli. Toxicological testing of the postmortem femoral blood was negative, and analysis of the vitreous humor was not performed.

Given the lethal trauma to the head and chest discovered through examination, the cause of death was certified as blunt trauma, and the manner as an accident.

DISCUSSION

The significant blunt force trauma demonstrated in these 2 cases collectively consist of tibia-fibula fracture, clavicle fracture, subarachnoid hemorrhage, calvarial and basilar skull fractures, pneumomediastinum, and rib fractures with associated laceration of thoracic organs, pneumothoraces, hemothoraces, and hemopericardium. These injuries are intermediate between those sustained in falls from standing and those sustained from falls from great heights.

Fatal falls from standing have traditionally been studied in the extremities of age. In the young, they are discussed in the context of accidental and nonaccidental pediatric trauma, whereas in the elderly, they are seen in accidental falls, most commonly at home. In the young pediatric patient, falls less than 10 ft (3 m) are unlikely to result in death, and if injuries are sustained, they are most likely linear, nondisplaced fractures of the calvarial skull and/or subdural hematomas.8–11 Falls in the elderly are associated with blunt head trauma that includes subdural hematomas, subarachnoid hemorrhage, and cerebral contusion, cervical vertebral fracture, and pelvic fracture that commonly results in the development of fatal pneumonias.12

Studied mainly in large urban settings where on-the-job construction accidents and intentional jumps from tall buildings are common, falls from heights are associated with classic injuries at autopsy examination.13–15 Textbook findings include aortic lacerations, vertebral compression fractures, ring fractures of the basilar skull, and calcaneus fractures with protrusion through the soles of the feet.16 Gupta et al15 classify falls between 10 and 20 ft as low falls, which are associated with a distinct set of findings as compared with falls from a greater height. Congruent with the presented cases, the authors describe isolated head injury, cervical spine fracture, forearm fracture, rib fractures with lung lacerations, and superficial abrasions and contusions all associated more so with low falls. Per authors, as the height of the fall increases so does the likelihood of sustaining injury to all 4 limbs, thoracic spine injury, pelvic fracture, and increasing chest as compared with abdominal injuries. The planned expansion of the border wall includes increasing the height of the wall to 30 to 50 ft (10 to 15 m). With this increase in height, there might be an associated shift in injuries sustained from falls. Türk et al13 noted that between 10 and 25 m, the severe craniocerebral injuries sustained in lower- and higher-level falls were not observed. Furthermore, above 10 m, the probability of sustaining more devastating injuries such as aortic rupture or pelvic fractures increases.

Previous research has shown that most deaths related to the unauthorized crossing of the Mexico–United States border are due to heat exposure, cold exposure, vehicular accidents, and drownings.17–19 During our study period, a total of 439 deaths occurred within the International Zone of New Mexico, of which an additional 6 were deaths in custody involving individuals crossing the United States–Mexico border (Fig. 4). Two individuals died of blunt force trauma incurred in a single vehicle crash during a high-speed chase with Border Patrol. Another 2 individuals were in a van with 10 others that crossed the border and then, in an attempt to evade Border Patrol, fled at high speed, lost control, and crashed. One decedent crossed the border with his brother after trekking through rough terrain without water for a long period, collapsing from environmental heat exposure before Border Patrol reaching the pair. The last was a man who died after ingesting a large quantity of methamphetamine while in a holding room after being detained by Border Patrol. An additional 6 cases were of unidentified skeletal remains, one of which was discovered by Border Patrol on horseback, consisting of modern clothing and a sleeping bag with evidence of animal predation. Another set of remains was found in the White Sands Missile Range by the Federal Bureau of Investigation while searching for a missing person from a southern town in New Mexico and contained keys, pants, bandana, and a large sum of money. An additional 3 sets of remains were found in Dona Ana County—one discovered by a couple looking for wreckage from a 1940s plane crash in an area known to be a high traffic area for border crossers, one set was incidentally discovered by an individual, and the third set was found by a hiker on private property near a hiking trail containing the identification card of a US veteran inside a weathered backpack. The remaining skeletal remains consisted of scattered bones that seemed to be pulled into a bush by animals and contained a gunshot wound on the head with a 40-caliber handgun found nearby and an identification card on the being. Based on circumstantial evidence, 2 of the 6 were likely New Mexico residents, 2 were likely border crossers, and 2 possibly belonged to either group. The remaining 405 deaths in the area covered a spectrum of causes of death from falls from standing in a residence to 4-wheeler accidents, with motor vehicle accidents not involving law enforcement comprising the overwhelming majority of cases followed by toxic ingestions.

FIGURE 4
FIGURE 4:
Deaths determined to be associated with crossing the United States–Mexico border.

Despite decades of existence and debate, there is exceedingly scarce data on nonlethal trauma sustained from unauthorized crossings of the southern US border. Indeed, a literature search yielded only 3 such articles—2 associated with border wall falls, 1 associated with border bridge falls, and none conducted in New Mexico.20–22 A neurosurgical study conducted by the only level 1 trauma center in southern Arizona found that over a 6-year period (2012–2017), 64 individuals were admitted with cranial and/or spinal trauma sustained from either jumping or falling from the border wall onto American soil.20 Whereas 1 patient had both traumatic brain injury and spinal fracture, all others had either cranial or spinal trauma. Spinal injuries were more than 3 times more common than cranial injuries and included, in decreasing order, burst fractures, compression fractures, and superior end plate fractures without obvious vertebral body fracture. Furthermore, all burst and compression fractures occurred in the lumbar spine. Cranial trauma included, in decreasing order, intracranial hemorrhage and traumatic brain injury, uncomplicated skull fractures, and an asymptomatic intracranial internal carotid artery dissection associated with basal skull fracture. In this series, no deaths occurred, and 73% were discharged in normal or near-normal condition to either their Mexican residence or to the custody of the US Border Patrol, 16% were transferred to either an inpatient rehabilitation unit or nursing facility in Mexico, and 11% to an acute care hospital in Mexico. An earlier study conducted by the orthopedic department of the same institution that cared for 174 individuals over a 6-year period (2004–2010) similarly found spinal injury to be common, with burst and compression fractures associated with landing on the feet.21 In the largest study of nonlethal falls, of 414 patients studied, 31% had spinal injuries, 27% had either head injury or distal lower-extremity (ankle/foot) fractures, and 13% sustained pelvic fractures, 7% femur fractures, and 5% either tibia fractures or intra-abdominal injuries to the spleen, liver, and kidneys.23 Of the spinal injuries observed, fractures occurred most commonly in the lumbar spine, followed by the thoracic spine and then the cervical spine, with 68% of all spinal injuries occurring between T10 and L3. Spinal fractures were not uncommonly multiple or discontinuous. There were no cases of aortic or hollow visceral injury. Of note, the average height of fall was 20 ± 10 ft, and only 6 individuals were excluded from analysis due to death, suggesting that falls from this height—roughly that of the border wall—typically result in injury rather than death by several measures of order. A study of falls from a slightly higher level in individuals falling from bridges at the southwestern US border revealed similar findings of common thoracolumbar spine fractures, craniocerebral injuries, and rarer intrathoracic and intra-abdominal injuries. This study found the most common injuries to be of the lower extremities, particularly of the tibia, fibula, ankle, and calcaneus, commonly with associated vertebral fracture owing to feet-first landings.22

A limitation of this study is that it is unknown how many, if any, died from similar falls onto Mexican soil. Two of the cases reviewed during this period involved those where injury or harm occurred in Mexico near the wall. The first case was of a young boy in a pick-up truck that was trying to cross a running water arroyo in Mexico who drowned as the truck filled with water. Mexican emergency medical services transported him to the United States/Mexico Port of Entry, where he was taken to a hospital on US soil, being declared dead in the emergency department. In the second case, an elderly man accidently ingested pesticide and was directed by the local Mexican hospital to seek care in New Mexico. The family made it to the Port of Entry, where cardiopulmonary resuscitation was initiated by US Customs. The decedent was in the process of transport by emergency medical services but died before reaching the hospital. It is reasonable to conclude that a fall resulting in severe, but immediately nonlethal trauma would likely have been brought into New Mexico for medical care and thus included in this series. Immediate lethal falls, however, remain unknown.

CONCLUSION

The border wall constructed between Mexico and the United States is a deterrent to the illegal, unauthorized passage between the 2 countries, but it is not benign—it has the capacity to severely injure and to cause death. Within the state of New Mexico, at a height of 18 ft, these falls tend to result in injuries seen in other low-level falls such as skull fractures, rib fractures with associated organ laceration, and single-limb extremity fractures. Planned significant expansion of the border wall across all 4 states carries with it a potentially substantial increase in the number of deaths directly related to the wall. Whether this represents redistribution from other causes of death related to border crossing in this region is yet to be determined. Further studies are needed to continue to aggregate information on fatal border wall falls and to compare these to nonlethal trauma sustained from similar falls.

Owing to the nature of the wall and the rough terrain traversed to reach it, with expansion, there is likely to be an increase in these deaths with more severe trauma sustained as the wall grows taller and longer.

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Keywords:

border wall; blunt trauma; falls; fall from height; New Mexico

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