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In a rural small town, a group of locals steps up to support senior health

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In a rural small town, a group of locals steps up to support senior health

Don Fitterer, 81, sits for a portrait at his home in Glen Ullin, N.D., on May 23. Fitterer is a participant in the Western Morton County Aging in Community program, which connects older adults in the medically underserved area of western Morton County with a variety of resources that can improve their quality of life.

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GLEN ULLIN, N.D. — When small rural towns get smaller, the challenges for those who remain get bigger. 

It’s especially true for older residents and those who care for them in this shrinking North Dakota town.

Adults age 65 and older make up a third of Glen Ullin’s roughly 700 residents. The town’s retired teachers, accountants and health care workers are making every effort to age at home, but one big obstacle for them is the ability to access medical care — without it, they are often forced to move to a larger city.

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Rural health care has been facing a crisis for years. But in rural towns such as Glen Ullin, older adults are getting help to manage, thanks to the handful of community members working to fill the gaps.

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A welcome sign stands alongside Highway 49, leading into Glen Ullin on May 24.

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Each person plays a separate role — from keeping lonely older adults company to springing into action when a health emergency arises. In rural towns experiencing a loss of people, jobs and resources, this network of support can make a big difference.

NPR visited some of them to see what obstacles they encounter when trying to make sure the community’s older adults have the care they need.

The program coordinator, a jack-of-all-trades

This photo shows Kyla Sanders helping 94-year-old Leona Staiger set up a medical alert device at her home in Hebron, N.D., on May 23. Both women are seated at a kitchen table, with Sanders on the right. Sanders, who has long hair and is wearing glasses and a horizontal-striped, short-sleeved shirt, is touching the device, which sits on the kitchen table. Staiger, who has short, silvery hair and is wearing a light-colored sweatshirt and glasses, is learning forward to look at the device. Kitchen cupboards, countertops and a fridge are in the background.

Kyla Sanders, the program coordinator for the Western Morton County Aging in Community program, helps program participant Leona Staiger, 94, set up a medical alert device at her home in Hebron, N.D., on May 23. Sanders wears many hats in her role.

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It typically starts with a concerned neighbor.

“They’ll say, ‘I haven’t seen him outside for six weeks,’ or something like that, and I’ll go tap on their door,” said Kyla Sanders, a coordinator for the Aging in Community program in western Morton County, where Glen Ullin is located.

It’s a pilot program at North Dakota State University Extension to support older people living alone in rural areas. The idea behind the initiative is that older adults living alone are at the greatest risk of struggling under the radar. They are also the most likely to move out of town to be closer to resources.

This photo shows Kyla Sanders delivering a meal to a resident at the Marian Manor senior apartments in Glen Ullin, N.D., on May 23. An older man wearing a plaid shirt and suspenders is seated at a kitchen table with his back to the camera. Sanders is standing next to the table with a hand near a brown paper bag. Kitchen cupboards and a stove are in the background.

Sanders helps deliver meals to a resident at the Marian Manor senior apartments in Glen Ullin on May 23.

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There’s no catch-all term for the work Sanders does. A former nurse and lifelong farmer, Sanders has the official title “program coordinator,” but her list of responsibilities changes every day — from setting up internet at an older person’s home to leading a flower arrangement class for a group of seniors to helping an older adult apply for Medicaid.

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She’s a firm believer that there are small, affordable ways to keep older people aging at home and that they don’t have to relocate to a large town or city to thrive.

This photo shows Kyla Sanders helping to deliver meals to residents at the Marian Manor senior apartments in Glen Ullin, N.D., on May 23. Wearing khaki pants and a striped, short-sleeved shirt, she's standing in front of a doorway on the right side of a hallway and is holding a brown paper bag and a container of food. Also in the hallway is a silver-haired woman wearing blue pants and a blue shirt. She's bending down toward a blue wagon to retrieve a brown paper package from it.

Sanders helps deliver meals to residents at Marian Manor on May 23. She says there are small, affordable ways to help older adults age at home.

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There are about 150 older adults whom Sanders visits or talks with regularly on the phone. According to Sanders, more than half the program’s participants don’t have family members living nearby or able to help. She suspects even more seniors are living alone in the greater region, and she hopes to expand the program out to 200 miles — about five times more than the distance she typically travels now.

“I think it’s such a treasure to be able to have older adults stay in place and that it just can’t be overlooked,” she said.

Kyla Sanders helps Don Fitterer, 81, fill out a health directive for local EMTs at his home in Glen Ullin, N.D., on May 23. Wearing dark pants and a dark red shirt, Fitterer sits near a kitchen counter on the right side of the photo. Sanders sits on the left side of the photo, wearing khaki pants and a short-sleeved shirt. She's holding papers in one hand; her other hand rests on an opened red folder on the countertop.

Sanders helps Don Fitterer, 81, fill out a health directive for local EMTs at his home in Glen Ullin. According to Sanders, many of the Western Morton County Aging in Community program’s participants don’t have family members living nearby or able to help.

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The nurse practitioner, aka the primary care provider

Rhonda Schmidt’s official title is “nurse practitioner.” But like in many small rural communities, she’s Glen Ullin’s main primary care provider.

On a regular day, Schmidt sees somewhere between 15 and 20 patients. Her core staff is made up of two other people — a nurse’s aide and a receptionist. Another nurse practitioner fills in once a week. Together, they handle medication refills and acute infections. But the clinic could do so much more if it had the staff, Schmidt said.

This photo shows the downtown of Glen Ullin, N.D., reflected in the window of the town's pharmacy on May 24. In the reflection is a low-slung brown brick building, a portion of which is labeled

A quiet downtown Glen Ullin is seen reflected in the window of the town’s pharmacy on May 24.

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For instance, X-ray tests can help identify pneumonia, a disease common in adults over 65. The clinic has the X-ray equipment but no technician to run the machine, according to Schmidt. A doctor from an affiliated hospital used to help fill that gap, but that is no longer the case.

CT scans are another service that’s limited at the clinic. Staff members who operated a mobile CT scanner used to visit once a week, according to Schmidt. Now, they come once a month.

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Dark rainstorm clouds skirt the horizon near Glen Ullin, N.D., on May 25. Below the clouds stretch green fields with occasional farm buildings.

A rainstorm skirts the horizon near Glen Ullin on May 25. Inclement weather and long travel distances to medical providers are barriers to health care access for older people in Glen Ullin and many parts of the rural United States.

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In North Dakota, only six out of 53 counties are considered to have enough health care workers, according to the Rural Health Information Hub.

Schmidt was born and raised in Glen Ullin. Of her four siblings, she’s the only one still in town, and she lives on the same dairy farm that she grew up on.

“I just feel it’s my job to make sure they get what they need,” she said of her patients. “If I can’t figure out how to see them, they’re going to have to drive or find a driver.”

The volunteer EMT crew

This photo shows Glen Ullin Ambulance Service EMTs Wade Kottre, Lori Kottre, Dwight Kuntz and Rita Wallin posing for a portrait on a county road in Glen Ullin, N.D., on May 25. Two of them are standing in front of an ambulance parked on the dirt road. One EMT sits in the ambulance's driver's seat, and the fourth EMT stands to the side of the ambulance. Behind them, the land slopes upward.

Glen Ullin Ambulance Service EMTs Wade Kottre (from left), Lori Kottre, Dwight Kuntz and Rita Wallin pose for a portrait on a county road in Glen Ullin on May 25. The ambulance service is staffed entirely by volunteers and provides an essential service for Glen Ullin and the surrounding area.

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Lori Kottre may work 9 to 5 as the office manager at Glen Ullin’s nursing home, but she serves around the clock as the town’s emergency responder.

“I have my pager on 24/7,” she said. “And if I’m gone from the office three or six hours a day, I make up my time here so that my job here isn’t neglected.”

This photo shows Glen Ullin Ambulance Service EMT Dwight Kuntz driving the team's vehicle through Glen Ullin, N.D., on May 25. He is seated with his hands on the steering wheel and is wearing a dark shirt, sunglasses and a baseball cap. Through the vehicle's windshield, one can see a couple of houses.

Glen Ullin Ambulance Service EMT Dwight Kuntz, who has been on the crew for 48 years, drives the team’s vehicle through Glen Ullin on May 25.

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This photo shows Wade Kottre on the left and his mother, Lori Kottre, on the right. Both are Glen Ullin Ambulance Service EMTs, and both are wearing dark polo shirts that say

Son and mother Wade and Lori Kottre, both Glen Ullin Ambulance Service EMTs, are pictured in Glen Ullin. Many of the ambulance volunteers are older adults themselves and have been on EMT crews for decades, but some younger locals have stepped up to join the team in recent years.

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Kottre has worked as a volunteer EMT for nearly 30 years, alongside her son, daughter, daughter-in-law and five others. Like Kottre, all of them have day jobs. In the U.S., more than half of rural EMS agencies are staffed by volunteers, compared with 14% in urban areas.

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The ambulance squad receives 120 to 150 calls a year — a majority of which involve older adults, Kottre said. This means that the calls the EMTs receive are almost always serious, such as cardiac arrest and strokes. But they are limited in how they can help.

The ambulance carries aspirin, EpiPens and medications to help treat chest pain and asthma. But with no paramedic on the squad, there is no one certified to insert an IV or place a breathing tube. In those cases, the EMT crew calls the ambulance service in Bismarck, North Dakota’s capital, to meet on the highway, typically about 17 miles out of town, and take over.

According to Kottre, the EMT crew wouldn’t be able to afford a paramedic. Many rural communities face that challenge as a result of a national paramedic shortage.

“They don’t stick around the small towns,” she said.

Still, Kottre tries to do the best with what she has.

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“I feel more responsible for trying to take care of the patients as good I can, because we know all of them — we know all of their children, all of their grandchildren,” she said.

The priest making home visits

This photo shows the Rev. Gary Benz offering Holy Communion to Marianne and Jim Schaaf, both in their 90s, at their home in Glen Ullin, N.D., on May 24. Both Schaafs are seated in armchairs in their living room, and Benz is standing in front of them, facing them. Many pictures hang on the wall behind them.

The Rev. Gary Benz offers Holy Communion to Marianne and Jim Schaaf, both in their 90s, at their home in Glen Ullin on May 24. Benz works to support homebound, often socially isolated older adults who are dealing with health concerns by offering them Communion and an opportunity to connect with someone each week.

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When he’s not at church, the Rev. Gary Benz spends his weekdays traveling to the homes of his aging parishioners who are too ill or weak to attend services. He makes about seven to nine trips a week. Initially, the purpose was to bring them Holy Communion, but he quickly learned that they needed something else — connection.

“They say, ‘Father, this illness or condition is weighing on me and it just takes away my joy,’ or ‘It gets lonely being alone here all day,’” he said. “Some of them have family and friends who come visit, which is good, but some, they’re the only person in their house.”

The photo on the left shows the Rev. Gary Benz sitting in a pew at the Sacred Heart Catholic Church in Glen Ullin, N.D., on May 24. His face is directed to the right, and he's wearing a dark top and clerical collar. The photo on the right shows people seated at the Sacred Heart Catholic Church with their backs to the camera, facing the front of the church.

Benz poses for a portrait at the Sacred Heart Catholic Church in Glen Ullin on May 24.

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Rural towns are often celebrated for their tight-knit communities and close bonds between neighbors. But even in areas where that holds true — like Glen Ullin — they face unique barriers to social connection, like distance, neighbors moving away and few opportunities to gather. According to the University of Minnesota Rural Health Research Center, older adults in rural areas report being lonelier than their counterparts in urban areas.

Loneliness can have detrimental effects on physical health, including increased risk of heart disease, stroke and dementia, according to a report from the U.S. surgeon general.

This photo shows the Rev. Gary Benz bidding farewell to Viola Weinhardt, 94, at her home in Glen Ullin, N.D., on May 24. Weinhardt is seated on a sofa with a blanket draped over her legs. A walker is on the left side of the photo. Benz is standing on the right side of the photo, with his hand outstretched and holding Weinhardt's hand.

Benz bids farewell to Viola Weinhardt, 94, at her home in Glen Ullin on May 24.

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Benz, who leads three congregations in neighboring counties, sees the need firsthand. It’s why home visits are important to him. On top of daily Mass and confessionals and leading the youth ministry, Benz rarely misses a home visit or room visits with nursing home residents.

“These people — it’s not just a euphemism — they become part of my family,” he said.

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This photo shows the Rev. Gary Benz greeting parishioners after a Saturday afternoon Mass at the Sacred Heart Catholic Church in Glen Ullin, N.D., on May 24. Five older adults stand around him, with their backs to the camera. Benz is wearing a religious garment and is speaking to them. A bulletin board is behind him on the wall, displaying various flyers.

Benz greets parishioners after a Saturday afternoon Mass at the Sacred Heart Catholic Church on May 24. Benz leads three congregations in neighboring counties but says he rarely misses a home visit.

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This story was supported by the Pulitzer Center on Crisis Reporting.

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Patient Aboard an Ambulance Fatally Stabs a Firefighter Paramedic

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Patient Aboard an Ambulance Fatally Stabs a Firefighter Paramedic

A member of the emergency medical services in Kansas City, Mo., died on Sunday after being stabbed by a patient who was being transported to a hospital in what officials said started out as a “routine medical call.”

The patient stabbed the emergency worker, Graham Hoffman, a 29-year-old firefighter paramedic, in the chest, piercing his heart, city officials said in a news release.

A suspect was in custody but had not been publicly identified. A motive for the attack was not immediately known.

The episode began after Kansas City police officers were dispatched to a “routine medical call” early on Sunday to check on a woman who was reported to be walking along a section of highway near North Oak Trafficway, the police said.

Officers found the woman and requested help from the emergency medical services for further unspecified treatment. While en route to the hospital, the patient “produced an edged weapon” and stabbed Firefighter Hoffman, the police said.

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Graham Hoffman, a firefighter paramedic, was fatally stabbed during a call in Kansas City, Mo., on Sunday.Credit…Kansas City Fire Department

Firefighter Hoffman’s partner called a crew emergency, and additional Fire Department and Police Department personnel responded. Firefighter Hoffman was taken to North Kansas City Hospital.

“Despite the heroic efforts of KCFD paramedics, the hospital medical team, Firefighter Hoffman succumbed to his injuries in the intensive care unit,” the city said.

Firefighter Hoffman had been a member of the Kansas City Fire Department since 2022, according to the news release.

The police are working with the Clay County prosecutor on criminal charges, the city said.

“We will demand accountability be applied not just to the suspect, but also for any steps in the system that fell short,” said Quinton Lucas, the mayor of Kansas City.

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Demand slump fuelled by Trump tariffs hits US ports and air freight

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Demand slump fuelled by Trump tariffs hits US ports and air freight

Donald Trump’s trade war with Beijing is starting to affect the wider US economy as container port operators and air freight managers report sharp declines in goods transported from China.

Logistics groups said container bookings to the US have fallen sharply since the introduction of 145 per cent tariffs on Chinese imports to the US.

The Port of Los Angeles, the main route of entry for goods from China, expects scheduled arrivals in the week starting May 4 to be a third lower than a year before, while airfreight handlers have also reported sharp falls in bookings.

Bookings for standard 20-foot shipping containers from China to the US were 45 per cent lower than a year earlier by mid-April, according to the latest available data from container tracking service Vizion. 

John Denton, secretary-general of the International Chamber of Commerce, said the upheaval in China-US trade flows reflected traders “kicking decisions down the road” as they waited to see how quickly Washington and Beijing could reach a deal to lower tariffs.

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A survey of ICC members conducted in more than 60 countries after Trump’s April 2 “liberation day” tariff announcement showed expectations that trade would be permanently impacted, whatever the result of coming negotiations.

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The cost of access to the US market would be the highest since the 1930s, Denton said. Referring to the baseline tariff for all countries, he said there was “almost an acceptance that 10 per cent will be the minimum charge to access US market, whatever other uncertainties there may be”.

Washington and Beijing showed signs of starting to feel the effects — with both sides announcing some tariff exemptions this week on important products for their respective economies and Trump predicting the 145 per cent tariff would “come down substantially”. However, China said on Friday it was not in talks with the US.

As the first container shipments from China to face tariffs are due to land in the US in the coming week, freight operators said supply chains were shifting.

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Nathan Strang, ocean freight director at US logistics group Flexport, said companies were waiting to ship goods in anticipation of Washington and Beijing agreeing a deal to mitigate the levies.

US importers are looking to use up stockpiled inventories before importing fresh stock from China, said logistics executives. They are also holding stock in bonded warehouses where inventory can be stored duty-free with taxes paid on withdrawal, or diverting it to other nearby countries such as Canada.

“They’re sitting on goods at origin, sitting on goods at destination,” Strang said, warning that if a deal was done to cut tariffs, shipping rates would then jump sharply.

Hapag-Lloyd, one of the world’s largest container shipping lines, said Chinese customers had cancelled roughly 30 per cent of its bookings out of China.

Column chart of Year on year % change in TEUs* showing Container bookings from China to the US are falling sharply

Hong Kong-listed Taiwanese container shipping company TS Lines has suspended one of its Asia to US west coast services in recent weeks. “Demand is not there,” one person at the group said.

The declines in order volumes have fed through to landings in Los Angeles, according to shipping data analysts Sea-Intelligence, which reported a surge in ‘blank sailings’, where scheduled vessels from China were being cancelled.

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Almost 400,000 fewer containers are booked on Asia to North America routes during the four weeks from May 5 than planned — a 25 per cent drop from the amount scheduled for the same period at the start of March, before tariffs were imposed.

The Port of Los Angeles alone expects 20 blank sailings in May, representing more than 250,000 containers — up from six in April.

That is a sharp fall from this week, when arrivals were up by 56 per cent year-on-year — a sign that importers have been frontloading deliveries from other south-east Asian manufacturing hubs such as Cambodia and Vietnam that are enjoying a 90-day “pause” in tariffs.

Container prices reflected the supply chain shift, according to data from logistics hub Freightos, with a 15 per cent increase in the price of a 40-foot container from Vietnam compared with a 27 per cent fall on major China-US routes.

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“Rates from other Asian countries to the US may continue to climb ahead of the July tariff deadline,” Judah Levine, head of research at Freightos, said.

Airfreight volumes have also fallen sharply, according to US industry association the Airforwarders Association, with its members’ bookings from China falling roughly 30 per cent.

“A lot of members have just stopped receiving orders from China,” said executive director Brandon Fried. “It’s also creating a whipsaw effect on prices and booking rates as traders reacted to each piece of news from the White House.”

The industry is expected to be further hit by a US decision to close its ‘de minimis’ scheme that allowed goods valued at under $800 to be imported tariff-free, an important route for e-commerce retailers such as Shein and Temu. Chinese goods are set to lose the exemption from May 2.

Lavinia Lau, chief commercial officer at Hong Kong’s Cathay Pacific, whose air cargo business contributes about a quarter of its revenue, said it expected a “softening” of demand between China and the US because of the tariffs and de minimis rule changes.

Hong Kong freight forwarder Easyway Air Freight said business from China to the US dropped roughly 50 per cent following the tariff increases.

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E-commerce executives noted waning freight demand. Wang Xin, head of the Shenzhen Cross-Border E-Commerce Association, said: “We are seeing noticeably fewer price quotation requests in relation to air cargo shipments.”

Even though stockpiling and supply-chain reorientation have helped buffer consumers from the sharp falls in freight volumes, hauliers and retailers are starting to feel the effects of the slowdown in imports.

Arizona-based Knight-Swift Transportation, one of the largest US trucking companies, warned of lower anticipated volumes, citing uncertainty caused by the tariffs threat.

Chief executive Adam Miller said some of the group’s largest customers were “expressing concern” that the cost of tariffs would feed into lower volumes in May.

“There are some that have told us that, yes, they’ve cancelled orders or they’ve stopped ordering, particularly from China, and we’ll figure out how to adjust their supply chain to avoid the cost,” he said.

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Retail consultants said purchasing patterns were reflecting the three successive months of softening consumer confidence indices.

John Shea, the chief executive of Momentum Commerce, which helps consumer companies sell about $7bn annually on Amazon, warned of a potential “double whammy” of rising prices and falling consumer spending.

“We’re seeing evidence that consumers are starting to trade down . . . while at the same prices are creeping up,” he said.

Data visualisation by Clara Murray

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The DEA says 114 immigrants in the U.S. illegally were arrested at a Colorado nightclub

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The DEA says 114 immigrants in the U.S. illegally were arrested at a Colorado nightclub

This screenshot from a video posted on X by the Drug Enforcement Administration’s Rocky Mountain Division shows law enforcement officers raiding a nightclub in Colorado Springs.

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Drug Enforcement Administration Rocky Mountain Division

The Drug Enforcement Administration says a raid carried out with other law enforcement agencies in Colorado Springs on Sunday led to the capture of more than 100 immigrants who are in the U.S. illegally.

The DEA’s Rocky Mountain Division said in a post on X that 114 immigrants were arrested and placed “on buses for processing and likely eventual deportation.”

The DEA said in a separate post earlier in the day that the “multi-agency enforcement operation” at an “underground nightclub” early on Sunday had also resulted in the seizure of drugs and weapons.

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The raid appears to be one of the largest single-day arrests of people without legal status since Trump was inaugurated in January, with a promise to conduct mass deportations.

Video posted online by the DEA showed an agent bashing through a glass window on the front of the building before people began streaming out of the front door, where law enforcement authorities were waiting. Officers, some of whom had guns drawn, shouted at the patrons to stop and get down. Many put their hands up or got on the ground.

The agency said it gave multiple warnings urging people inside to come out before the raid. More than 200 people were in the club, authorities said, and arrests began around 3:45 a.m. local time.

Attorney General Pam Bondi said that the club was “frequented by Tda and MS-13 terrorists.” That is likely a reference to Tren de Aragua, the Venezuelan gang that has been a target of Trump administration deportations in the U.S.

NPR could not immediately verify the legal status of those arrested, and whether there’s any evidence of gang membership.

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Bondi said two people were also arrested on existing warrants, and that authorities seized “cocaine, meth, and pink cocaine.”

In a video posted online by Denver7 News, DEA Special Agent in Charge Jonathan Pullen said “what was happening inside was significant drug trafficking, prostitution, crimes of violence — we seized a number of guns in there.”

Pullen added that there were over a dozen active duty service members in the club either as patrons or working as armed security guards.

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