IMPERIAL SAND DUNES, Calif.—Adrenaline surged as several agents, part of an elite Border Patrol unit, heard the 911 call on their radios. They leaped up from their lunch break, abandoning freshly served diner food, and rushed out to their vehicles.
“People got out of our way pretty quick,” said agent Travis Carter, a new medic on the 15-man Border Patrol Search, Trauma, and Rescue (BORSTAR) team. The agents looked formidable in their multi-camo uniforms, with equipment pouches and gear strapped on.
A recreational sand dune car had rolled and the driver was injured. Response time can be critical for crashes in the dunes, which often involve broken bones, head injuries, spinal injuries, and even fires.
“I always want to be the first guy there. I want to be doing the work, I want to be in charge,” Carter said.
It takes grit and tenacity to make it in BORSTAR. The demands of the five-week induction course alone are so high that 75 to 80 percent drop out.
BORSTAR specializes in targeting transnational criminal organizations and cross-border criminal activity in remote areas. In many ways, it operates like a paramilitary unit; it’s headquartered on the Fort Bliss military base in El Paso, Texas.
All 15 members of the Yuma unit are EMT-certified and five are medics; they’re all adept at rope rescue, swift-water rescue, police diving, and land navigation. Three agents are also K-9 handlers capable of tracking humans, as well as finding cadavers.
Locally, they help law enforcement recover drowning victims, or use their K-9s to track lost Alzheimer’s patients. They run police dive courses and active shooter drills.
On this holiday weekend, though, they’re at the Imperial Sand Dunes in California, providing emergency medical response to the thousands of people who flock to the dunes to camp out and play in their sand vehicles—from motorbikes to ATVs and off-highway vehicles, such as sand rails and RZRs.
“This operation this time of year is where we cut our teeth,” Carter said. “This is where you find out whether or not you have what it takes to operate here as a medic.”
On the Scene
Carter and his partner for the day, agent Gary Wegener, took off, lights and sirens blaring. The location they’d been given was “southwest of Buttercup Ranger Station,” which meant somewhere in the middle of the sand dunes between the ranger station and the U.S.–Mexico border fence.
The three-mile drive along Interstate 8 from Duner’s Diner took a little longer than usual; everyone had reduced their trucks’ tire pressure from about 45 PSI to around 15 PSI to handle driving in the sand dunes. Too much speed on a highway could rip the tires off their rims.
Carter and Wegener headed into the dunes, scouring the area for anyone trying to flag them down. They were poised to call out the exact GPS coordinates to the rest of the team as soon as they had contact with the injured man.
“We finally get to the top of a hill and [see] a guy standing on top with a motocross bike and he’s jumping up and down waving his arm,” Carter said. They navigated around two large sand bowls toward him, and he pointed out the crash site.
Wegener called out the GPS coordinates over the radio and within five minutes the whole team was on-site.
“When we pulled up, you could tell that the guy’s RZR [sand vehicle] wasn’t in terrible shape,” Carter said. It had rolled but landed upright, and its structure was intact. “You could see the guy sitting there [and] and you can tell he’s uncomfortable.”
His arm was clearly injured, bent in an unnatural shape. But sometimes it’s the injuries not visibly apparent that are the most dangerous, so the medics have to check everything.
Carter knelt next to the man, Fernando, to find out what happened. Fernando and his friend had traveled across from Mexico to hire an RZR and play in the sand dunes for the day. It was the first time he’d driven one and the rookie mistake of quickly turning back up a hill had ended in a bad day for him, although his friend was uninjured.
Fernando knew his name, what day it was, and what had happened.
“To me, it says, OK, he’s mentating correctly. He’s getting oxygen and blood flow to his brain,” Carter said.
“I look into his eyes. Pupils are equal. I don’t need to be worried about a head injury—yet.”
He asked fellow medic Eric Carrillo to take Fernando’s vitals, while Wegener prepared to set an IV line.
While all this was happening, the other agents were picking up ancillary work—one called for an ambulance, another was next to Carter, writing time-stamped notes on everything, from vitals to responses. Others pulled out the stretcher; the ambulance would only be able to go as far as the ranger station.
Carter asked for a C-collar to be fitted around Fernando’s neck after he complained of neck and back pain. His main concern was to prevent any further or lasting damage, “because preservation of life and preservation of quality of life is of utmost importance,” he explained later.
Then it was time to fully check Fernando’s left arm, and his sleeve was cut to the shoulder. The arm was lumpy and clearly going in directions it shouldn’t be going in. The bottom two bones (radius and ulna) were obviously broken—both had punctured the skin, then were sucked back in when the upper bone, the humerus, also broke.
“Once I saw that whole thing, I said to the other medic, ‘Hey, I think this is a level one trauma. Would you agree?’” Carter recounted.
Carrillo agreed, which meant transport was upgraded to a helicopter flight.
“It might be able to be fixed here in Yuma, but it’s not necessarily going to be fixed as best as it would in San Diego or Phoenix at a level one trauma center,” Carter said. “Because you’re talking about involving the vasculature and involving the nerves and everything else. We just talked about quality of life.”
By helicopter, they could get Fernando to a hospital in San Diego, 140 miles away, faster than they could get him out of the sand dunes and into an ambulance for the 20-mile ride to the Yuma hospital.
The rest of the team responded immediately—one canceled the ambulance and requested a helicopter. It would arrive in 22 minutes. Another two grabbed a green smoke flare and headed up on a rise, ready to indicate to the pilot where to land.
Fernando had to be readied for transport.
Giving him painkillers and stabilizing his broken arm were the two immediate priorities, in that order. BORSTAR had been on the scene for about 10 minutes by this point, and Fernando said his pain level was close to 10 out of 10.
Wegener had successfully placed an IV line in Fernando’s right arm, and Carrillo administered an anti-nausea medication before giving half a dose of fentanyl, an opioid 100 times more potent than morphine.
“You wouldn’t give fentanyl to somebody with a head injury, but we’d already trended his vital signs,” Carter said.
Fernando’s pain dropped to seven out of 10 and his vitals were still strong, so the second half of the dose was given.
Straight away, his pain dropped to five out of 10 and he stopped wincing or grimacing when his arm was touched.
“So we started with securing his arm. We secured it to his body with a SAM splint and two slings,” Carter said. SAM splints contain foam and aluminum that can be manipulated around a fracture.
By now, the helicopter was in sight and the green smoke flare had been deployed. Once the helicopter landed, the onboard paramedic disembarked and conferred with Carter about the injury and treatment details.
She advised them to give Fernando a further 50 micrograms of fentanyl before moving him.
Carrillo, now on patient lead, gave the fentanyl; the team secured Fernando to the stretcher, and six men carried him 120 feet to the waiting chopper.
Once the helicopter took off to San Diego, the adrenaline and hyper-focus gave way to relief. The men circled up for an impromptu debrief.
“Everything went well. It was a good response, a good job by everybody. I think that was the best we could do for that guy,” Carter said later.
He feels the pressure of commanding such a situation, especially with more severe injuries.
“I guess for me, that’s the major challenge … human lives being at stake,” he said.
“When something goes wrong for most people in their career, it’s like, ‘Oh, I cost my company money.’ Or ‘I made a mistake and made my company look bad.’
“My mistake is that somebody doesn’t see their dad again, somebody doesn’t see their son, somebody doesn’t see their family member again.”
Providing a Service
The Imperial Sand Dunes sit in southeast California and run north for around 40 miles from the U.S.–Mexico border in a five-mile-wide band. The Bureau of Land Management manages the dunes, and users pay a fee from Oct. 1 through April 15 each year. Permits are $35 to $50 per week or $150 for the season.
Between the Buttercup area and Glamis, which is 30 miles north and home to larger dunes, the Thanksgiving weekend can attract up to 200,000 campers and off-highway vehicle enthusiasts. Some of the sand rails with souped-up Corvette engines are worth half a million dollars, said supervisory BORSTAR agent Chad Smith.
Every year, the BORSTAR unit assists with emergencies.
Carter has only been a medic since September and hadn’t responded to any major trauma calls until this Thanksgiving weekend.
The previous morning, they’d attended to a man who’d rolled his vehicle several times right near a campground and had likely broken his back. The day before that, a woman with a broken collarbone was patched up and sent to the hospital. Another man was airlifted out with a burned leg from an ATV crash.
“And now having had these calls where we’ve had these incidents, it helps you feel more comfortable in your decision-making and in your skill and your ability to evaluate situations,” Carter said.
A Hard Road
Carter dreamed of joining BORSTAR for many years—his brother had been in BORSTAR and his father was once a Border Patrol agent.
But he had to overcome some personal setbacks first.
After graduating from Arizona State University with a bachelor’s in criminal justice studies in 2011, Carter injured his knees.
“I tore the cartilage off of my left femur. I had three knee surgeries on my left leg,” he said.
He was then faced with the choice of a knee replacement—which would prohibit him from ever joining Border Patrol—or an experimental STEM cell therapy.
His dream was Border Patrol, so it was an easy choice. The STEM cell therapy worked, but while his left knee was recovering, the right knee blew out and required the same treatment.
“January of 2014 was the first time I started running. And then I got in the Border Patrol [in July] and I was like, OK, I know where I want to go. I know where I’m headed. I’ve just gotta stay on that path,” he said.
“It took me a while to rehab and get my knees and my legs strong enough to make it through BORSTAR.”
He completed the eight-week EMT certification in September 2017 while he was still a Border Patrol agent and then made the cut for BORSTAR in May 2018.
“It was one of those things, I know what I want to do—pain, all that stuff, it doesn’t matter, you know? It’s like anything, if you want it bad enough, you won’t care what the obstacle is. You’ll get through it. You’ll find a way. And, yeah, I deal with knee pain all the time, [but] for this, I mean, it’s a no brainer.”
Becoming a Medic
Carter’s decision to become a medic was solidified just weeks after he became an EMT, at the end of 2017.
“I was off duty. I was driving to Phoenix with my wife and kids, and I saw a pretty nasty motorcycle accident happen right in front of me,” he said. He grabbed his medical bags and rushed to help.
“I was trying to work two people, and they were probably 25, 30 yards apart. So I was just running in between two people doing the best I could to get vital signs, doing my best to get IV lines established.
“The only thing I could do was my basic EMT skills. I did everything I could, but there’s probably more I could have done as a medic, if I had the skills and the equipment.
“I [did] the best that I could. It just didn’t work. It didn’t work out for one of those people. One lived, one died.
“The person died on the operating table from blood loss. That was rough. So it was like, OK, what happens if that next wreck, that’s my family?
“So I tried to train at the highest level to make sure that if I do encounter a situation … I’m not going to feel that helpless.”
Looking back now as a medic, he knows it’s impossible to predict whether he could have saved that life that day. But he did everything he could to prepare himself for the future.
Ramping Up Again
The unit just regained Carter and Carrillo in September as they graduated from their one-year medic training. Smith is hoping four more will go to medic school in 2020.
“We want to get as many medics and dog handlers as we can,” he said.
BORSTAR is half of the special operations division of Border Patrol. The other half is the tactical unit, BORTAC. Each of the nine southern border Border Patrol sectors has a BORSTAR unit within their special operations divisions.
“A lot of what we do is very, very paramilitary,” Smith said. “We’ll try to do three weeks of operations and one week of training, every month.”
The unit spent much of fiscal 2019 augmenting Border Patrol during an unprecedented crisis that saw a 160 percent spike in illegal border crossings into Yuma. Border agents averaged almost 5,700 apprehensions per month.
But now that the numbers have dropped to less than 800 per month, BORSTAR is getting back to normal operations.
“I can remember times finding 1,000 pounds [of drugs] in one night. And there hasn’t even been a hint of that lately,” Smith said.
The unit will gather intelligence on “where we’re getting beat” by the cartels and focus efforts there, often at night, Smith said.
Usually, it’s in the expanse between Tucson, Yuma, and Gila Bend, a “no man’s land” that’s difficult to patrol consistently. Smith suspects the illegal aliens and drug smugglers are currently traveling during the daytime, as there’s limited pressure forcing them into nighttime travel.
He said BORSTAR’s “bread and butter” is targeting a remote area where the cartels operate, usually to the east of Yuma on the Barry M. Goldwater bombing range.
The agents will stage themselves at a forward operating base right near the U.S.–Mexico border and head out multiple times over a week, placing agents in the mountains to watch around the clock and interdiction teams on the ground.
“We just sleep in our trucks, or put out a sleeping bag or something like that, so we can be more efficient, coverage-wise, in a given area,” Smith said.
He said BORSTAR isn’t bound by the union rules that Border Patrol agents operate under, so they have more freedom in their operations.
“We’re on-call 24 hours a day,” he said. “The southern border … is filled with a lot of tiny, tiny little law enforcement agencies. They don’t have the funds to be able to have full-time dogs or divers or medics or things like that. So we get a lot of calls to help those other agencies out.”
BORSTAR also knows the favored pick-up points on the highways. They stage interdiction teams a few miles to either side and follow a pick-up vehicle after it has been loaded with aliens or drugs.
“We’d follow it to the [stash] house, and then from there we could get a warrant and serve an immigration warrant on the house. That’s where our BORTAC unit would come in and they’d serve that warrant,” Smith said.
He said now the pick-up drivers are often hired through Craigslist for a couple of hundred dollars per job.
“You’re not getting any information out of them. They genuinely don’t know anything,” he said.
They’ll also respond to 911 calls from lost or injured aliens in the desert.
“[Smugglers are] heartless, with their own people. They’ll bring them across and then they’ll just leave them to die,” he said.
The unit also sees its fair share of death. They recover an average of five drowning victims a year, mostly from the surrounding canals; and they’ll come across dead bodies in the desert, often aliens that have succumbed to heat-related injuries. The average daily temperature sits above 100 from June through September.
Border Patrol agents can try out for BORSTAR after two years of working on the border. But it’s so tough that Smith said 75 to 80 percent drop out of the five-week course.
“There are tests that they have to take and sometimes guys will fail those. But, for the most part, it’s usually the physical portion of it. Guys will drop out because they just physically can’t go through it,” Smith said.
Aside from the usual timed run, sit-ups, and push-ups, BORSTAR hopefuls need to complete a litter-carry for six miles through the hills, Smith said. The litter, like a stretcher, has a 160- to 190-pound mannequin on it.
The medical and tactical skills the BORSTAR unit brings to bear are as important as the way the team operates. The mission is the focus for this unit, but the camaraderie is the glue.
“No matter what … you’ve got guys that are committed to the mission and committed to each other,” said Carter.
“I’ve been on rescues that have taken one hour and I’ve been on rescues that take 17 hours. It doesn’t matter what it is, you’re going to have a full buy-in from everybody and nobody’s leaving anybody behind. Everybody’s willing to sacrifice for each other. Everybody is 110 percent committed to whatever that mission is, and they’re going to work until every resource, every lead, has been exhausted.”
No one leaves at the end of a long day until everyone has finished their tasks; they’re constantly jumping in to help each other.
And they’re friends. Their Thanksgiving dinner was at Carter’s house, and Smith hosted the Christmas party.
“There’s not one guy on this team that has a house project or has a move, or has anything to do with their family, that the other guys aren’t willing to pick up the slack for,” Carter said.
“The brotherhood’s what makes it easy to endure the long hours, the nights away from family, the misery, sometimes, sitting up on hills in 30-degree weather. You’re like, OK, well, this sucks, but somebody else’s going through it right here next to me, so screw it. It’s worth it.”
BORSTAR acting commander Luis Saucedo said, “Having a team like this makes my job as a supervisor easy.”