This article is made possible through Spotlight PA’s partnership with NOTUS, a nonpartisan news organization that covers government and politics with the fresh eyes of early career journalists and the expertise of veteran reporters.
PHILIPSBURG — Emergency responders sped out of a Pennsylvania immigrant detention center on a recent Saturday morning, sirens blaring as they drove past more than 20 protesters demanding the lockup’s closure.
It was the Moshannon Valley EMS crew’s second run to the Geo Group-owned site that day.
The number of detained immigrants the crew serves has grown by 44% since President Donald Trump returned to office. The Moshannon Valley Processing Center now holds nearly 1,700 people, according to the Deportation Data Project — a population more than half the size of the town.
The nonprofit has responded to 43 calls at the detention center since October, EMS chief Fred Ferguson said during a recent interview in the back of one of Moshannon Valley’s five ambulances.
Immigration and Customs Enforcement hasn’t paid them for any of those calls yet, he said.
“We have to have some faith that someone’s going to do the right thing and compensate us for the work that’s provided,” Ferguson said. “But you have to be hesitant as well.”
Like many providers of rural health and emergency care, the Moshannon Valley EMS is stretched thin. Staffers sometimes have to come into work when they’re off duty. Between gas, wear-and-tear and staff wages, just driving an ambulance out of the station costs around $800, Ferguson said.
“We are used to doing more with less,” he said.
Rural emergency services across the country face a demand they can’t readily meet at times as ICE scales up its detention capacity. First responders already dealing with few resources and long drives to hospitals are handling expanded populations. The migrants themselves are left waiting for emergency care for urgent medical needs, according to records of 440 calls to 911 from detention centers in rural areas of Pennsylvania, Louisiana, Georgia, Indiana and Texas.
The calls, most of them from the second half of 2025 and obtained by public requests, feature people requiring treatment for chest pain, pepper-spray exposure and assault. They include calls about children as young as 8 months old, as well as some of the 50 deaths in ICE custody since Trump returned to office. They paint a picture of how reliant immigrant detention centers are on local emergency services — and the strain that massive detention centers can put on the communities where they’re located.
At another Geo Group detention center in Louisiana, staff called 911 four times in 38 minutes on Nov. 18, repeatedly asking how long it would take for an ambulance to arrive.
“We’re short on ambulances,” a dispatcher said on the third call.
“It’s been 22 minutes,” responded an exasperated staff member at the Central Louisiana ICE Processing Center. “I know we may be short an ambulance, but I got a guy here that’s in dire need to get out of here.”
Detention center employees didn’t provide the man’s age or symptoms. During the third call, a dispatcher said she could send an ambulance that was 40 minutes away.
That detention center holds 1,300 detainees in Jena, a town of roughly 4,100. Four ambulances answer calls in the region, and the nearest small hospital is less than 2 miles from the detention center. More complex emergencies require transport to the Rapides Regional Medical Center, 38 miles away.
Four days earlier, a dispatcher told an employee at the center that it would be “just a bit” before she could send an ambulance for a man with chest pain.
“We were actually gonna send him by Geo van, but Geo didn’t want us to take him all the way to Rapides having chest pain,” the employee said.
“I guess that’s OK,” the dispatcher responded, laughing. “It is what it is.”
The call ended with the dispatcher saying she might have to send an ambulance from a hospital 18 miles away.
Geo Group did not respond to questions about specific incidents. But a spokesperson said the company provides ready access to off-site EMS when needed.
“While GEO’s health care service capabilities cover a wide range of services and treatments, at times we may utilize Emergency Medical Services to address medical needs, as necessary,” the spokesperson, Christopher Ferreira, said.
Along with the Central Louisiana and Moshannon Valley detention centers, NOTUS obtained records of 911 calls from the Stewart Detention Center in Georgia, an Indiana prison loaning beds to Immigration and Customs Enforcement, known as the “Speedway Slammer,” the South Texas ICE Processing Center and the Dilley Immigration Processing Center.
Geo Group also operates the South Texas ICE Processing Center. Another giant prison group, CoreCivic, runs the adult facility in Stewart, Georgia, and the family one in Dilley, Texas.
With detention center populations surging and oversight shrinking, immigrants and groups such as the American Civil Liberties Union have sued the Trump administration over conditions detainees are subjected to, including lack of medical care. The independent watchdog for ICE and the DHS found violations of detention standards, including health and safety issues.
The Department of Homeland Security repeatedly dismisses reports of inadequate care, saying health care provided in detention is “the best healthcare illegal aliens received in their entire lives.”
Some of this medical care happens outside the detention facilities. 911 dispatchers routinely answer multiple emergency calls a day from detention centers. Of the hundreds of calls NOTUS reviewed, 42% took place the same day staff at the lockups had already requested help.
At the South Texas ICE Processing Center in Pearsall, a rural residential city off I-35 between San Antonio and Laredo, dispatchers had to send ambulances to transport five detained immigrants on Oct. 24, 2025:
At 8:47 a.m. a 34-year-old man reported hypertension.
At 3:03 p.m. a 62-year-old man reported chest pain.
At 3:11 p.m. a 43-year-old woman reported hypertension.
At 6:30 p.m. a 28-year-old man reported high blood pressure and chest pain.
At 9:20 p.m. a 67-year-old man reported chest pain.
There’s a hospital less than half a mile from the detention complex, but some incidents require ambulances to take detainees to the teaching hospital in San Antonio, a drive that can take more than an hour.
The Miami Correctional Facility — a prison in the small town of Bunker Hill, Indiana — started holding immigrants in civil detention in October.
Within two weeks of immigrants arriving, emergency dispatchers fielded two calls in the middle of the night: The first involved two men who had been in a fight, and the other, less than an hour later, requested an ambulance for a 44-year-old man who was unconscious and didn’t speak English. The records don’t include information on whether the people involved in the incidents were ICE detainees or prisoners.
Two people in ICE custody have died this year at the Indiana prison, which currently holds more than 500 immigrants — in a town of under 1,000 people. The Indiana Department of Corrections, which operates the facility, did not respond to NOTUS’ request for comment.
Staff at the Central Louisiana ICE Processing Center called 911 twice last August after employees used pepper spray in a dormitory. At least two detainees needed to go to the hospital, and multiple people required stretchers, the staff told 911 dispatchers.
Last year, ICE’s inspectors found that the facility didn’t follow recording standards in use-of-force incidents.
In one call, the nurse at the detention center hesitated before explaining the situation to the dispatcher.
“We had a issue in the dorm, where they sprayed the whole dorm with the pepper spray or whatever,” the nurse said. “We’ve got multiple people in medical, and they’re asking for another stretcher out on the walk, and I don’t have one; the only thing I know to do is to call y’all.”
The dispatcher said the ambulance would be there in 20 to 25 minutes.
A lack of timely EMS access is widespread in rural communities. Response times in rural areas average 73 minutes, according to a 2022 policy brief from the National Advisory Committee on Rural Health and Human Services. This means a single call at a detention center could take an ambulance out of commission for hours.
The Moshannon Valley crew in Pennsylvania primarily responds to 911 calls in two vast counties that are home to roughly 16,000 people. Often, the EMS team assists smaller companies deeper in the mountains that only have one ambulance each.
Compared to the number of calls the emergency responders tend to, roughly 3,500 annually, the volume coming out of the detention center is not overwhelming the crew, Ferguson said. The lack of payment isn’t hurting their bottom line so far.
The Moshannon Valley EMS has 10 full-time employees and 35 part-time staff. On a recent Monday morning, a team of six gathered at the station, a barn-like building between a gas station and old train tracks. They chitchatted about coffee orders and filled out paperwork around a folding plastic table, waiting for the alarm signaling an emergency.
The team received 16 calls within the span of roughly 12 hours, more than usual ahead of a Monday evening, which tends to be one of their busier nights.
None of the 16 calls that day were for the detention center, and the team has only gone there twice in June. But the 911 call records obtained by NOTUS showed 52 calls to 911 for the center from July to December last year, many of them for chest pain and heart problems.
Responding to calls at Moshannon Valley Processing Center often takes at least an hour, between traveling to the facility and then to the nearest hospital able to treat patients with chest pain, strokes and other cardiovascular issues.
Philipsburg’s hospital shuttered two decades ago, leaving only an urgent care clinic; none of the detainees needing emergency help ended up there.
The effects of delayed care can be catastrophic.
“If you have somebody who needs emergent care and you can’t get there for an hour — if you’re having a heart attack or a stroke — those things make a big difference, because there are only certain interventions that you can get within a six-hour window or a one-hour window,” said Amy Zeidan, an assistant professor at Emory University’s Department of Emergency Medicine, who studies healthcare at immigration detention centers.
In the last half of 2025, completed emergency-response times at the Pennsylvania detention center averaged an hour and 45 minutes, the second-longest median completion time of the detention centers NOTUS reviewed. (These figures include state police, county services and the county coroner, along with EMS.)
NOTUS wasn’t able to obtain the data for calls to the Central Louisiana ICE facility to determine the completion time. But at the other facilities, the median completion time was close to an hour or longer.
At the South Texas facility, the median call took 58 minutes. At both the Indiana and Dilley centers, the median was an hour and 9 minutes. At the Stewart Detention Center, it was 2 1/2 hours.
CoreCivic spokesperson Ryan Gustin said the company’s facilities can’t control EMS response times. Staff can take detainees in vans to receive medical care, but they’re not set up as ambulances, he said. And the county has a limited number of ambulances.
“If our medical team determines the wait for EMS arrival is too long, facility protocols allow for transport via facility vehicle at the direction of medical staff,” Gustin said in a statement.
The Stewart Detention Center is in such a rural area that the facility’s detained population of nearly 2,000 is double the population of the adjacent town of Lumpkin.
Two suicides have taken place there during Trump’s second term.
EMS from a neighboring county arrived 35 minutes after staff found Denny Adan Gonzalez, 33, suspended from a sheet in his cell on April 28, the Atlanta Community Press Collective reported. All of Stewart County’s ambulances were tending to other emergencies.
“Unfortunately that is the reality, and it is very common in Stewart seeing that it takes longer for them to arrive and to provide the immediate emergency care that people need,” said Amilcar Valencia, the executive director of El Refugio, an advocacy group for immigrants held at the detention center. “If they need to be transported to the hospital, it will be another 45 minutes.”
The county has two ambulances running around the clock, while nearby counties have just one.
“Given that asset, we are not over-burdened here,” Mac Moye, the county manager, said in a statement.
As in Philipsburg, ICE hasn’t paid the EMS in Stewart County for responding to the detention centers’ calls, Moye said.
In January, months after payments from the government to the EMS stopped, ICE asked the Moshannon Valley crew’s billing company if they would still respond to calls at the detention center, Ferguson said.
“We will never stop delivering medical care to individuals that need it, no matter who they are,” he said.