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 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.
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...
Many trafficking victims are seen by health care professionals and unrecognized as victims. All health care workers should be aware of the signs of trafficking and know what to do.
It's a brilliant plan. However, these victims may not be able to read, and have significant language barriers. If the message is received, the staff can get a translator, at least on a phone. 87% is way too high to not implement protocol at ANY facility.
Specializes in Psychiatric nursing; Medical-Surgrical.
Aren't sex trafficker's reading this too to stay aware. Can't we all have an inhospital policy or special code for giving the victim an upper hand so the trafficker will not be aware?! Just saying.
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...
The situation is sad and pathetic, but I agree that adding more irrelevant questions to every patient's triage is not the answer. We already have a plethora of pointless questions that we plow through with every arrival. We're forced to waste over half of our triage time on clearly irrelevant garbage. (Do we really need to ask a 64-year-old guy with a cut finger who walks in with his wife of 40 years if he is being abused, if he is suicidal, if he has traveled outside the US or been exposed to any communicable diseases, if he is a fall risk etc...? When patients complain about all the irrelevant questions, my pat answer is: "Hey, big brother is watching out for you. Your government wants to be sure we don't miss anything important while you are here with your cut finger.")
I vote to add an awareness module into our mandatory annual online learning, but the suspicious symptoms and behaviors are already known red flags. Emergent's common sense approach of a protocol for removing visitors for a candid conversation with anyone who has signs of abuse or shaky registration information makes more sense than one more wide net hitting those who are obviously not candidates.
In Virginia the State Police are working with the State to provide training, education, resources to address this growing problem. We had training at one of the local hospital were one of the state investigators gave us very specific information. They estimate there are 300,000+ victims per year and the majority have contact with some kind of first responders, most in the ED. The things to watch for, and how to talk with them, is different than others types of abuse.
Our DV screening questions are part of a set of secondary triage questions which are asked by the primary nurse once a patient gets back to the room. There is an option to click "visitors in room" or "cognitively impaired" as an option for the direct screening questions.
The victim in this article was saved by a savvy flight attendant. Awareness is #1, and what to do is #2. Our facility has made it a mandated report. If we suspect trafficking we are to call the police. This flight attendant is my hero!
Eight people were found dead and about 30 others injured inside a brutally-hot semitrailer parked in a Walmart parking lot in San Antonio, Texas in what authorities are calling "a horrific scene."
Police described the incident as an apparent "human trafficking crime."
Authorities became aware of the truck overnight after a Walmart employee, who had been approached by someone who had been in the truck asking for water, notified police of the interaction, San Antonio Police Chief William McMorifice said this morning at a press conference, alongside other officials from the city.
It sounds like that was more of an illegal immigrant smuggling operation. There have been cases like this before where people died.
Isn't human trafficking more of a slavery situation where people are held against their wills? I thought it illegal immigration, because people were seeking to work in the United States and pay smugglers a price to sneak them into the country, some of whom are quite unscrupulous.
I believe they are stating this is human trafficking because these people were locked in the van once it arrived at the Walmart parking lot and then the story indicates that people in cars would come to the truck and pick up people from the van.
Yes, human trafficking is considered forced labor or some type of sexual servitude.
However, illegal immigrants could be part of the human trafficking trade if they are forced to work when they arrive in the US in order to pay for their passage
I believe Emergent is right. If you pay someone for illegal transport, and they provide it with no strings, it is smuggling. Once strings are attached either disclosed prior or sprung as a surprise it becomes trafficking.
nurse2033, MSN, RN
3 Articles; 2,133 Posts
Many trafficking victims are seen by health care professionals and unrecognized as victims. All health care workers should be aware of the signs of trafficking and know what to do.