“Nobody Wants to Die That Way”: The Intersection of Immigration Enforcement and Emergency Medical Services in a Rural South Texas County

Abstract The purpose of this study was to explore the influence of migration and immigration enforcement on this inland, rural community’s EMS clinicians and first responders. We conducted 13 in-depth interviews with emergency responders in a rural county in Texas. Interviews were conducted between May 25–28, 2025. Thematic analysis using inductive, latent coding was performed using NVivo 14. Our analysis identified three primary themes: (1) Severe Negative Impacts of Immigration Enforcement on Emergency Responders, (2) Frequent and Necessary Collaboration with Border Patrol Agents, and (3) Positive Influence of Operational Lone Star Funding to Support Response to Migrant Health Emergencies. These themes highlight the ways that border enforcement and infrastructure contribute to situations that perpetuate the need for emergency services, the complexity of providing emergency care in a border security environment, and policy changes that have positively impacted emergency responders and the community in response to stated need. Elements of the intensive U.S. border security network bring already stretched local emergency responders on a collision course with the morbidity and mortality outcomes facilitated by border security infrastructure. This increases the negative impacts on local emergency responders, but funding specific to support medical response provided through border security initiatives can alleviate many of the challenges.