Human Trafficking Recognition in the ED

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.

Human Trafficking Recognition in the ED

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.

Journal of Emergency Nursing. Implementation of Human Trafficking Education and Treatment Algorithm in the Emergency Department

National Human Trafficking Hotline

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traumaRUs

About traumaRUs, MSN, APRN

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Specializes in ICU; Telephone Triage Nurse.

OMG - that is brilliant. That blue dot idea really should win someone a Noble Peace prize. God bless the ED staff everywhere. You all really make a huge difference (for my part in telephone triage I attempt to keep every patient or parent out of the ED for colds, rashes, constipation, and all other non emergent illness better managed by primary care or urgent care). You all have your hands full.

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Is anyone using the blue dot? It's a great idea. My one thought is that I'd think people would want to post instructions for the blue dot in the bathroom - lots of places post women's shelter and similar information in the bathroom. I'd think the blue dot system would be most successful if it weren't posted anywhere but instead women were notified on a case-by-case basis. Otherwise it wouldn't take long for abusers to catch on to the system.

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Specializes in ER, ICU.

This is a short training video, feel free to share

[video=youtube_share;FTcagl-zlC0]

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Specializes in ICU.

This is a great article! I work in an area that is notorious for human trafficking, and I don't believe we use a tool like this in our triage. I wonder how effective the implementation of these programs are (staff buy-in as opposed to exasperation at having another form to complete) and what the process is like. Has your hospital tried something similar?

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Specializes in ICU.
Is anyone using the blue dot? It's a great idea. My one thought is that I'd think people would want to post instructions for the blue dot in the bathroom - lots of places post women's shelter and similar information in the bathroom. I'd think the blue dot system would be most successful if it weren't posted anywhere but instead women were notified on a case-by-case basis. Otherwise it wouldn't take long for abusers to catch on to the system.

Really good point. Wondering if this would discourage abusers from allowing victims to seek medical treatment and whether we would miss opportunities to screen/identify victims...

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One of my questions while reading the article was how the patient would have an opportunity to honestly answer the domestic violence screening questions (which I find nearly worthless as part of a rapid triage process).

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Specializes in Nephrology, Cardiology, ER, ICU.

I worked in a large inner city ED for 10 years and agree that the "domestic violence" questions are very difficult to ask in a rapid triage situation.

It sounds like from the above comments no one is using this system except the authors? I will try to reach out to the authors and see if we can get some assistance with the implementation of this...

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Specializes in Family Practice.

While human trafficking is absolutely abhorrent, we can't look at things in a vacuum. So you recognize this trafficking victim...what exactly do you think is going to happen to them? It's not rainbows and cupcakes. Typically they are incarcerated and when they are released, they now have a criminal record so it's very difficult to find jobs. Many times they end up back where they came from.

What happens after a human trafficking victim is 'rescued'? | TheHill

Underage Sex Trafficking Victims Are Treated as Criminals in the U.S. | New Republic

Sex-Trafficking Victim Arrested for Selling Sex - Hit & Run : Reason.com

I could list hundreds of additional articles regarding the criminalization of trafficking victims but you get the point. The Polaris Project is one of the most vocal groups regarding human trafficking but they actually offer zero resources to victims once they are rescued. In puritanical America, this is typically how it goes. We must save these people but once saved, sorry, you're on your own.

If you really want to help, please contact your local SWOP chapter. They do so much for sexworkers and trafficking victims. Push for decriminalization of sexwork because that is the only way to truly help trafficking victims. If they can't be arrested, they have so many more opportunities for a better life.

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Specializes in Critical Care, ER, Cath lab.

Not long ago we actually called US Marshalls on a possible human trafficking case. After all was said and done he told us the most common cases are Asian women. He also said to watch for access to a cell phone. If they have no phone or access to one then it's likely a human trafficking case.

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Specializes in Nephrology, Cardiology, ER, ICU.

Agree the Polaris Project seems to be the gateway for info on human trafficking.

Came across this in my local paper - a story out of Chicago:

Bail Denied Man Charged with Sex Trafficking Slain Teen

CHICAGO (AP) — A Chicago man is being held without bond on sex trafficking charges after federal prosecutors alleged the defendant attempted to recruit a woman to replace another who was killed.

Assistant U.S. Attorney Christopher Parente on Thursday said 33-year-old Joseph Hazley told a girl he used to pimp and that he had no money coming in after 16-year-old Desiree Robinson was slain. Robinson was allegedly killed last year by a man who answered an online sex ad.

Hazley was arrested in June on charges alleging he trafficked Robinson for more than a month before her Christmas Eve slaying.

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Specializes in ER.

I personally don't think the Ed is an effective way to counter the ever increasing demands to solve a myriad of social problems that we are being asked to address during a triage. I really think this type of outreach belongs in a different setting.

The ED triage is supposed to be a focused assessment to deal with the problem at hand. Often there are people accompanying the patient, which makes it impossible to ask the very personal questions that we are supposed to ask. The blue dot idea is clever, but word of this will spread like wildfire. It will hardly be a secret.

I find, the more questions I'm forced to asked during triage that aren't relevant to the case at hand, the less effective the whole thing becomes.

If a woman (or man) comes in with signs of abuse, the protocol should be that no other person is allowed in the room, and a very frank, real discussion should be had. This is a commonsense approached that, unfortunately, is lacking today. Instead we like to cast a wide net, by asking everyone a bunch of screening questions, but we rarely catch any fish that way...

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