Human trafficking is not limited to third world countries where children are pulled off the streets to work in the sex industry. It occurs in the US just like other countries and with the same devastating consequences.
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Human trafficking is defined as, "the recruitment, transfer, harboring, or receipt of persons by threat or use of force, for induced commercial sex acts, and sexual servitude." This definition comes from a recent study published in the Journal of Emergency Nursing.
The sex trafficking trade is here in the US. Atlanta is sometimes referred to as the "hub" of the US trade. Its a big city, with many conventions, events, things to do and it has a very busy airport where people can come and go often in a single day. CNN recently explored the sex trafficking industry in Atlanta.
It is estimated by the Department of Justice that the profits from sex trafficking exceeds 32 billion dollars per year. The National Human Trafficking Hotline reports that they have received over 145,000 signals (including emails, calls, webform reports) since 2007 of potential sex trafficking cases. And, it occurs in every state.
A lit review from the article in the Journal of Emergency Nursing provides this statistic: "87% of victimssought medical treatment during captivity without recognitionor rescue."
How to recognize possible sex trafficking victims in YOUR ED? Its estimated that only 1% are identified when they seek emergency care as they are frequently on the move, knowledge deficit of the ED personnel, and the victim's inability to escape.
The Emergency Nurses Association released a new study in the Journal of Emergency Nursing detailing an evidence-based project that puts a spotlight on the importance of formal education, screening, and treatment protocols for emergency department personnel to guide identification and rescue victims of human trafficking.
The program tested in the study showed success with screening tools, awareness of medical red flags of human trafficking, and a silent visual notification to help victims safely ask for help.
The Journal of Emergency Nursing study developed these guidelines for practice:
Screening began at the registration desk, where personnel looked for social signs of trafficking. Social signs of trafficking include no insurance, offer to pay cash, nopersonal identification, no guardianship documentation,and a patient who is with a person who does all of the talking.
If registration personnel identified a possible victim or if the patient answered yes to questions in our existing domestic violence screening, the emergency nurse completed the Department of Health and Human ServicesScreening Tool for Human Trafficking which was embedded in the electronic health record.
In recognition that victims may be fearful of the trafficker overhearing a conversation, a silent visual notification tool was implemented to notify staff of abuse or unsafe living situations.
Signage was located in bathrooms and instructed potential victims to place a blue dot on the specimen cup when giving a urine specimen. A blue dot on the specimen cup triggered the use of the thescreening tool by the emergency nurse.
To ensure patient safety, all team members were also alerted of the blue dot, and the patient was taken to a designated safe area within the department for care.
If there was a positive response to the screening, the following steps were implemented:
The emergency charge nurse conducted a huddle with the physician, security, social services, and nursing leadership. During the huddle, plans were made for further assessment and rescue.
A room in the radiology department was used as a private place to interview the patient without the trafficker present because it is common practice for patients to be alone when radiographs are taken.
An emergency nurse and social worker escorted the patient to the radiology area for a private screening.
For victims younger than 18 years, a report was immediately filed with child protective services as required by law, and the victim received intervention.
Safety of the victim, staff, other patients and security of the hospital campus are always paramount and protocol is followed:
When a potential victim was identified, security personnel participated in our huddle and remained in the department.
While health care providers ensured that the patient received adequate medical and nursing care, security managed any threats to safety and tried to detain the trafficker until local law enforcement arrived.
If the trafficker attempted to flee the hospital, security was instructed to contact local police and maintain the safety of the hospital campus.
By adding a sex trafficking screening tool to your already-existing domestic violence protocol, ED personnel can save lives.
And...that's what we are about!
Does your ED have a sex trafficking protocol?
References:
Farella C. Hidden in plain sight: identifying and responding to human trafficking in your ED. ENA Connect. 2016;40(4):4-22.
