Slavery is alive and well
This article came out last month in Annals of EM. Honestly, I didn't want to read it at first. I knew it would make me sad. But I can't bury my head in the sand and pretend like this isn't happening. It is. And I need to know about it. We need to know about it. Because where will these patients come? To us...to your ED and mine. So I am facing my sadness and am going to summarize this article as a way to fight back. Surprisingly, I feel a ray of hope. If we can learn how to spot this and help one person out of this vortex of abuse and pain, we have done a beautiful thing. So let's dig into the article.
This problem is rampant. I won't go into all the stats, but read the article. It is appalling. Anyone could become a victim. 63% of US-based human trafficking survivors went to the ED at some point. Odds are, I have seen these people and not realized it. Most don't self-identify. They present with "physical injuries, untreated chronic health conditions, substance abuse, and sexually transmitted infections."
Here are some tip-offs from the article. The following bullets are quoted.
- "The person accompanying your patient is reluctant or unwilling to leave the patient with the care team Traffickers may present themselves as a partner, family member, friend, or advocate. Traffickers may also be a partner or family member.
- The patient has a vague or inconsistent history of present illness or injury, or the history is inconsistent with the complaint or injury.
- A trafficked patient may have an unexpected demeanor; he or she may be irritable or anxious, have a flat affect, or offer poor eye contact.
- A trafficked patient may not know his or her home address or how to get home from the ED.
- A trafficked patient may not be in possession of his or her ID card(s) or may have unexpectedly few personal items."
We need to have clear goals. "The primary goal of an encounter with a possibly trafficked patient is to establish the ED as a haven from trauma or exploitation and to offer available resources if possible. The goal for the encounter is not necessarily disclosure or rescue."
Interviewing Tips (Quoted from the article.)
"Always separate the potential victim from accompanying persons.
Foster trust and build rapport with the patient.
Sit at eye level when asking questions.
Maintain eye contact.
Meet immediate physical needs (eg, food, water).
Use a trained interpreter when needed.
Ask specific questions about safety.
Do Not Be Afraid to Ask
Where do you live?
Who takes care of you?
Do you feel trapped in your situation?
Is anyone forcing you to do things you do not want to do?
Has anyone threatened your family?
Tell me about your tattoo.
Has anyone at home or work ever physically harmed you?
Have you ever been denied food, water, sleep, or medical care?
Term to Avoid
Pimp" (end quotation from the article)
Basic institutional protocols need to consider the following. Quoted...
- "List of clinical indicators that should arouse suspicion for trafficking
- Clinical priorities for caring for a victim of trafficking
- Institutional contacts (social work, forensic examiners, security) to help care for a victim of trafficking
- Institutional security plan for identified victims of trafficking
- Local mandatory reporting laws.
- NHTRC hotline: 1-888-373-7888
- Local human trafficking resources for referral
- Local forensic examiner information and guidelines for referral
- Local and national law enforcement contact information and guidelines for referral"
Each patient needs to be considered as an individual. The primary goal is treatment of emergency conditions. Then the patient's wishes for the degree of assistance must be respected. Sadly, some are not ready to leave the situation. But establishing the ED as a safe haven for them to return is a good start. Posting hotline information in the waiting room and especially the bathroom is a great way to empower victims to seek help on their own and in a way they deem best.
Let's Fight Back Together
Human trafficking is a tragic problem. We play a vital role in ending slavery as emergency care providers. We also have financial resources we can contribute. Please follow me in making an end of the year donation to International Justice Mission or the charity of your choice to combat this evil.
Our community of "spoon-feeders" can band together and give the gift of freedom this holiday season. Here is a video about IJM. Careful, it will break your heart like it did mine.
Ann Emerg Med. 2016 Oct;68(4):501-508.e1. doi: 10.1016/j.annemergmed.2016.03.049. Epub 2016 Apr 26.
1Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA; ACEP Public Health and Injury Prevention Committee. Electronic address: email@example.com.
2Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; HEAL Trafficking.
3Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA; ACEP Public Health and Injury Prevention Committee.
4Department of Emergency Medicine Residency, University of Iowa School of Medicine, Iowa City, IA; ACEP Academic Affairs Committee.
5Pali Momi Medical Center, Emergency Services, Aiea, HI.
6ACEP Academic Affairs Committee; Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, TX.
7Emergency Medicine Residency, John Peter Smith Health Network, Fort Worth, TX, and the EMSC.
8HEAL Trafficking; Departments of Emergency Medicine and Medicine, Harvard Medical School, Boston, MA.
9ACEP Public Health and Injury Prevention Committee; Bronx Lebanon Hospital Center, Bronx, NY.
10ACEP Public Health and Injury Prevention Committee; Department of Emergency Medicine, University of Texas-Houston, Houston, TX.
Human trafficking is a significant human rights problem that is often associated with psychological and physical violence. There is no demographic that is spared from human trafficking. Traffickers maintain control of victims through physical, sexual, and emotional violence and manipulation. Because victims of trafficking seek medical attention for the medical and psychological consequences of assault and neglected health conditions, emergency clinicians are in a unique position to recognize victims and intervene. Evaluation of possible trafficking victims is challenging because patients who have been exploited rarely self-identify. This article outlines the clinical approach to the identification and treatment of a potential victim of human trafficking in the emergency department. Emergency practitioners should maintain a high index of suspicion when evaluating patients who appear to be at risk for abuse and violence, and assess for specific indicators of trafficking. Potential victims should be evaluated with a multidisciplinary and patient-centered technique. Furthermore, emergency practitioners should be aware of national and local resources to guide the approach to helping identified victims. Having established protocols for victim identification, care, and referrals can greatly facilitate health care providers' assisting this population.
Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
PMID: 27130802 [PubMed - in process]