Human Trafficking and the Emergency Nurse

Abstract

How many times have we as emergency nurses provided care for victims of human traffickers without even knowing it? While we are well aware of the societal scourge that is human trafficking, we frequently don’t transfer that awareness to our practice setting. In this editorial I am urging you to do just that. Human trafficking is defined as “The recruitment, transportation, transfer, harboring, and receipt of persons by means of threat, force, or other means of coercion, of abduction, of fraud, of deception, of the abuse of power or a position of vulnerability or the giving or receiving payment or benefits to achieve the consent of a person having control over another person for the purpose of exploitation.”1Patel RB Burke TF Human trafficking in the emergency department.Western J Emerg Med. 2010; 11 (Accessed at www.Medscape.org January 21, 2106): 402-404PubMed Google Scholar While there is no way to know exact numbers of victims of this crime, it is estimated to affect up to 2oo million people worldwide.1Patel RB Burke TF Human trafficking in the emergency department.Western J Emerg Med. 2010; 11 (Accessed at www.Medscape.org January 21, 2106): 402-404PubMed Google Scholar Estimates for the United States are just as difficult to achieve due to the hidden nature of the crime but according to the ENA Position Statement: Human Trafficking Patient Awareness in the Emergency Setting, the United States government places the number at about 17,500 foreign nationals and an estimated 200,000 American children at high risk for trafficking into the sex industry each year.2Emergency Nurses Association, Position Statement, Human trafficking patient awareness in the emergency setting, accessed at www.ena.org January 21, 2016.Google Scholar Victims of human trafficking have health needs just as the rest of the population, but are unlikely to have a usual provider. This means that they turn to the emergency department for treatment of illnesses and injuries. We most often think of victims of human trafficking as female and trapped in the sex industry, and approximately 75% are. The other 25% are both males and females in forced labor situations such as domestic help, manual labor, drug trade, and agriculture. The range then of presenting symptoms in the emergency setting can be varied. What are the cues that the patient you see might be a victim of human trafficking? There are a few that are worthy of suspicion and further exploration. They include: not being in control of one’s own identification (insurance card, driver’s license, etc.) little knowledge of whereabouts, unable to state address or where living or other common aspects of the community speaks little or not at all 3rd party insists on being present (or interpreting) presence of injuries (type, multiple, both old and new) inconsistent story with injuries or when asked to repeat signs of malnourishment fear, anxiety expressed, especially re: law enforcement demeanor is submissive, affect flat presence of sexually transmitted infections or sexually related injuries If you suspect the patient before you is a victim of human trafficking, what actions should an emergency care provider take? First is identification of the human trafficking situation if at all possible. Ask the questions! Second is to address the presenting symptoms / chief complaint and provide appropriate care for that. Third is to offer appropriate safety options. While victims younger than age 18 must be reported to child welfare authorities, adults must be given information and allowed to make their own decisions. Only they know what potentially worse outcomes might occur if they seek to escape at that time. Any actions to remove themselves from this type of modern day slavery might further endanger themselves or others, and so they decline. If safe, however, it is important to give information about how help can be accessed if desired at a later time. That information should include local services such as safe houses, domestic violence shelters, or social service agencies. There is a national help hotline at the National Human Trafficking Resource Center. The phone number is 1-888-373-7888. It is important to note that emergency care providers can also access this number to report suspected instances of human trafficking. This phone number also serves as a tip line that can lead to additional investigation without involving the patient. More information about human trafficking resources include the Polaris Project (www.PolarisProject.org), Human Trafficking Information and Resources or Emergency Health Care Providers (www.humantraffickinged.com) and fact sheets can be obtained at the National Human Trafficking Resource Center (www.acf.hhs.gov/trafficking/about/factsheets.html) or (www.TraffickingResourceCenter.org). In addition, ENA has a well written Position Statement: Human Trafficking Patient Awareness in the Emergency Setting that can be found in this issue of JEN or accessed at www.ena.gov.