Identification and Management of Human Trafficking Victims in the Emergency Department
Human trafficking, believed to be the third-largest criminal activity in the world, is a form of modern-day slavery where people are bought, sold, and smuggled, often beaten, starved, and forced to work as prostitutes with little or no pay.1
It is a human rights violation that severely impacts millions of people worldwide. Emergency nurses have a unique opportunity to recognize victims of human trafficking and intervene. A recent study revealed that of 173 U.S. victims surveyed, 68 percent had presented to a healthcare provider at least once while being trafficked, most frequently to an emergency department provider.2
Determining the magnitude of human trafficking has proved challenging for law enforcement, policy makers, and trafficking advocates due to the covert nature of the crime and the prevalence of hidden populations.3 The United States government estimates approximately 17,500 people are trafficked nationwide.4 Researchers found that 87.8 percent of surveyed trafficking survivors were seen by a healthcare professional during captivity and went undisclosed, resulting in a missed lifesaving opportunity.5 63 percent of those surveyed were specifically examined in an emergency department.5
Healthcare access for these victims is limited and most will only have one opportunity to be examined by healthcare professionals. At present, the research is limited concerning the effectiveness of training for the emergency department staff on identification and treatment of human trafficking victims. 6 Additionally, limited availability of emergency department-specific screening tools and limited established reporting requirements, together with the barriers to patients disclosing their involvement in trafficking, make it difficult to identify these patients and provide the proper care and advocacy.
Unfortunately, these victims rarely identify themselves, and the failure to recognize victims reduces the opportunity to provide resources to such victims. Only 40.7 percent of the emergency departments specifically screened adults for human trafficking, with most ED clinical staff using one or more safety questions as their screening tools.7 Of the 59.3% of the emergency departments that did not screen adults specifically for human trafficking, several screened only children; some focused on domestic violence or abuse/neglect screening; others asked questions about safety in general but clarified that it was not specific to screening for human trafficking; and some offered no information on any actions taken in the emergency department related to human-trafficking screening.8
Typically, these victims report a high incidence of health issues such as physical abuse, sexually transmitted infections, undernourishment, and psychological trauma. When a victim seeks medical attention, this presents healthcare staff a rare opportunity to recognize victims. Hence, healthcare facilities, especially emergency departments, become the venue for identifying victims of human trafficking, providing a prospective safe haven for victims. To combat human trafficking, healthcare workers need to be trained on how to identify and approach such victims and understand what actions to take once a victim is identified.
At the health facility, screening begins at the registration desk, where the staff can look for signs of trafficking. Signs may include the patient has no insurance, guardianship information, and personal identification, the patient offers to pay with cash, or the patient may be with another individual who answers all the questions for the patient.7 If registration personnel are successful in identifying a possible victim, or if the screening for human trafficking indicates abuse, the emergency nurse can take further actions to provide help and resources.
Other red flags that may help identify victims of human trafficking include: The patient is unaware of his/her location, the patient exhibits fear, anxiety, depression, and avoids eye contract, and the patient is reluctant to explain his/her injuries.7 In addition, emergency department nurses need to know the common signs that victims of human trafficking present with to the emergency department. The most common signs of trafficking are bruises, broken bones, scars, pelvic inflammatory disease, urinary tract infections, multiple abortions or pregnancies, sexually transmitted infections, malnutrition, feelings of helplessness, shame, humiliation, and confusion.9 As victims may be fearful of the trafficker accompanying them, sometimes a silent visual notification tool can be implemented to notify staff of abuse or unsafe living situations. After that visual tool has been identified, the team members should be alerted immediately, and the patient can be escorted to a designated safe area until further steps can be taken.
If human trafficking, exploitation, or slavery is suspected, an advocate, such as a social worker or case management, should be contacted to assess the victim’s needs and educate the patient about his/her rights. If the victim is an adult, law enforcement should be contacted only after obtaining patient consent. If consent is not obtained, the patient should be given the number to the National Human Trafficking Hotline to memorize and resources should be provided. If the victim is a minor, law enforcement should be contacted to report suspected abuse.
Increasing the understanding, knowledge, and skills of ED staff and providers is essential for accurate identification of such victims so resources can be provided. MEDHOST Emergency Department Information System (EDIS) allows for screening tools to be built per your needs, as well as charting choices that can be created to help your facility identify victims of human trafficking. To learn more about how MEDHOST EDIS can help run your hospital more efficiently with customizable tools, please reach out to us at firstname.lastname@example.org or call 1.800.383.6278.
1 U.S. Department of Justice. (2019). Human trafficking/involuntary servitude. Federal Bureau of Investigation. Retrieved from https://www.fbi.gov/investigate/civil-rights/human-trafficking
2 Breuer, G. J. & Daiber, D. (2019). Human trafficking awareness in the emergency care setting. Journal of Emergency Nursing, 45(1), 67-77. https://doi.org/10.1016/j.jen.2018.11.011
3 Hachey, L.M., & Phillippi, J.C. (2017). Identification and management of human trafficking victims in the emergency department. Advanced Emergency Nursing Journal, 39(1), 31-51. https://doi.org/10.1097/tme.0000000000000138
4 Ahn, R., Alpert, E. J., Purcell, G., Konstantopoulos, W. M., McGahan, A., Cafferty, E., … Burke, T. F. (2013). Human trafficking: Review of educational resources for health professionals. American Journal of Preventive Medicine, 44(3), 283–289. https://doi.org/10.1016/j.amepre.2012.10.025
5 Lederer, L. J., & Wetzel, C. A. (2014). The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals of Health Law, 23(1), 61–91.
6 Donahue, S., Schwien, M., & LaVallee, D. (2019). Educating emergency department staff on the identification and treatment of human trafficking victims. Journal of Emergency Nursing, 45(1), 16-23. https://doi.org/10.1016/j.jen.2018.03.021
7 Egyud, A., Stephens, K., Swanson-Bierman, B., DiCuccio, M., & Whiteman, K. (2017). Implementation of human trafficking education and treatment algorithm in the emergency department. Journal of Emergency Nursing, 43(6), 526-531. https://doi.org/10.1016/j.jen.2017.01.008
8 Dols, J. D., Beckmann-Mendez, D., McDow, J., Walker, K., & Moon, M. D. (2019). Human trafficking victim identification, assessment, and intervention strategies in South Texas emergency departments. Journal of Emergency Nursing, 45(6), 622-633. https://doi.org/10.1016/j.jen.2019.07.002
9 Lamb-Susca, L. & Clements, P.T. (2018). Intersection of human trafficking in an urban emergency department. Journal of Emergency Nursing, 44(6), 563-569. https://doi.org/10.1016/j.jen.2018.06.001