Human Trafficking
Ronna G. Miller
Search for more papers by this authorAsha K. Tharayil
Search for more papers by this authorBrian L. Miller
Search for more papers by this authorBrandon B. Morshedi
Search for more papers by this authorRonna G. Miller
Search for more papers by this authorAsha K. Tharayil
Search for more papers by this authorBrian L. Miller
Search for more papers by this authorBrandon B. Morshedi
Search for more papers by this authorDavid C. Cone MD
Professor of Emergency Medicine
Yale University School of Medicine, New Haven, Connecticut
Search for more papers by this authorJane H. Brice MD, MPH
Professor of Emergency Medicine
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Search for more papers by this authorTheodore R. Delbridge MD, MPH
Executive Director
Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland
Search for more papers by this authorJ. Brent Myers MD, MPH
Chief Medical Officer ESO Associate Medical Director
Wake County EMS, Raleigh, North Carolina
Search for more papers by this authorSummary
Human trafficking (for sex or labor) is a common, global problem. Children, teens, and adults experiencing human trafficking are often “hidden in plain sight.” This chapter describes many environmental (scene) and individual (patient) indicators of human trafficking. Recognition of indicators is the first, critical step toward providing trauma-informed, culturally sensitive, person-centered care, including referral to resources targeting the patient's emergency (and longer term) needs. This chapter also describes the role of EMS system medical directors, including familiarization with local human trafficking laws and implementation of protocols that include education and training; patient screening, care, and support guidelines; reporting procedures (especially where required by law); and performance improvement procedures. These measures may not only save the life of individual patients experiencing trafficking, but also reduce human trafficking in the community.
References
- United Nations Office on Drugs and Crime . Global Report on Trafficking in Persons . 2018 . Accessed July 5, 2020. Available from: https://www.unodc.org/documents/data-and-analysis/glotip/2018/GLOTiP_2018_BOOK_web_small.pdf .
- International Labour Organization, Geneva . 2017 . Global estimates of modern slavery . Accessed July 5, 2020. Available from: https://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/documents/publication/wcms_575479.pdf .
- National Human Trafficking Resource Center . National Human Trafficking Resource Center Data Breakdown 2015 , quoted in: U.S. Department of Justice, Office for Victims of Crime, Human Trafficking 2017. Accessed July 5, 2020. Available from: https://www.ncjrs.gov/ovc_archives/ncvrw/2017/images/en_artwork/Fact_Sheets/2017NCVRW_HumanTrafficking_508.pdf .
- Shandro J , Chisolm-Straker M , Duber HC , et al. Human trafficking: a guide to identification and approach for the emergency physician . Ann Emerg Med . 2016 ; 68 : 501 – 8 , e501.
- Lederer LJ , Wetzel C . The health consequences of sex trafficking and their implications for identifying victims in health care facilities . Ann Health Law . 2014 ; 23 : 61 – 91 .
- National Association of State EMS Officials (NASEMSO) . Falls Church, VA : National Model EMS Clinical Guidelines . Version 2.2. January 2019 . Accessed September 29, 2020. Available from: https://nasemso.org/projects/model-ems-clinical-guidelines/ .
- Bledsoe BE , Porter RS , Cherry RA . Paramedic Care: Principles and Practice . 5th ed. Upper Saddle River : Pearson , 2016 .
- Sanders MJ , McKenna K , American Academy of Orthopaedic Surgeons (AAOS) . Sanders’ Paramedic Textbook . 5th ed. Burlington, MA : Jones & Bartlett Learning , 2019 .
- Foresman-Capuzzi J , Petrillo TM . Child maltreatment . In: S Fuchs , M McEvoy , ed. Pediatric Education for Prehospital Providers . 4th ed. Burlington, MA : Jones & Bartlett Learning , 2021 .
-
Donnelly E
,
Oehme K
,
Barris D
,
Melwin R
.
What do EMS professionals know about human trafficking: an explorative study
.
J Hum Trafficking
.
2018
;
5
:
325
–
35
.
10.1080/23322705.2018.1501258 Google Scholar
- Augustine J. Eagles Survey Consolidated Results: Human Trafficking . July 2020 .
- U.S. Department of Justice . 2020 . Human trafficking defined . Accessed July 5, 2020. Available from: https://www.justice.gov/humantrafficking
- Polaris Project . National Human Trafficking Hotline . Accessed July 5, 2020. Available from: https://humantraffickinghotline.org/
- U.S. Department of Justice. Office of Juvenile Justice and Delinquency Prevention. Washington (DC) . Commercial Sexual Exploitation of Children . Accessed July 5, 2020 . Available from: https://ojjdp.ojp.gov/programs/commercial-sexual-exploitation-children .
- Goldberg AP , Moore JL , Barron CE . Domestic minor sex trafficking: guidance for communicating with patients . Hosp Pediatr . 2019 ; 9 : 308 – 10 .
- National Center for Missing and Exploited Children–Child Sex Trafficking Identification Resource . Accessed July 5, 2020 . Available from: https://www.missingkids.org/content/dam/missingkids/pdfs/CST%20Identification%20Resource.pdf .
- Polaris Project . 2017 . The Typology of Modern Slavery: Defining Sex and Labour Trafficking in the United States . Accessed July 5, 2020. Available from: https://polarisproject.org/wp-content/uploads/2019/09/Polaris-Typology-of-Modern-Slavery-1.pdf .
- Florida State University . Office for Victims of Crime: What EMS Need to Know About Human Trafficking . Accessed July 5, 2020 . Available from: https://dvmedtraining.csw.fsu.edu/training/ems/ .
- Menaker TA , Franklin CA . Commercially sexually exploited girls and participant perceptions of blameworthiness: Examining the effects of victimization history and race disclosure . J Interpers Violence . 2013 ; 28 : 2024 – 51 .
- Cunningham KC , Cromer LD . Attitudes about human trafficking: individual differences related to belief and victim blame . J Interpers Violence . 2016 ; 31 : 228 – 44 .
- Polaris Project . 2020 . Myths Facts and Statistic . Accessed June 13, 2020. Available from: https://polarisproject.org/myths-facts-and-statistics/ .
- U.S. Department of Homeland Security: Blue Campaign . 2016 . Myths and Misconceptions . Accessed June 8, 2020. Available from https://www.dhs.gov/blue-campaign/myths-and-misconceptions .
- Diagnosing human trafficking when a patient is a victim . Patient Safety Monitor Journal . 2017 Aug. Accessed June 13, 2020. Available from: https://www.hcpro.com/NRS-331417-868/Diagnosing-Human-Trafficking-When-a-Patient-is-a-Victim.html .
- Coppola JS , Cantwell R . Health professional role in identifying and assessing victims of human labor trafficking . J Nurse Pract . 2016 ; 12 ( 5 ): e193 – e200 .
- Operation Texas Shield . 2019 . 5 Reasons Why It is Growing . Accessed June 15, 2020. Available from: http://www.operationtexasshield.com/#5-reasons-why-it-is-growing-i .
- THORN . 2018 . Survivors Insights: The Role of Technology in Domestic Minor Sex Trafficking . Accessed June 7, 2020. Available from: https://www.thorn.org/wp-content/uploads/2019/12/Thorn_Survivor_Insights_090519.pdf .
- U.S. Department of Health and Human Services, Office on Trafficking in Persons . 2014 . SOAR Online: SOAR to Health and Wellness Online Training Module. 2019. Accessed June 6, 2020. Available from: https://www.acf.hhs.gov/otip/training/soar-to-health-and-wellness-training .
- Covenant House . Homelessness, Survival Sex and Human Trafficking: As Experienced by the Youth of Covenant House . New York . May 2013 . Accessed June 6, 2020. Available from: https://humantraffickinghotline.org/sites/default/files/Homelessness%2C%20Survival%20Sex%2C%20and%20Human%20Trafficking%20-%20Covenant%20House%20NY.pdf .
- Gibbons P , Stoklosa H . Identification and treatment of human trafficking victims in the emergency department: a case report . J Emerg Med . 2016 ; 50 : 715 – 19 .
- Goldenberg SM . Trafficking, migration, and health: complexities and future directions . Lancet Glob Health . 2015 ; 3 : e118 – 9 .
- Hachey LM , Philippi JC . Identification and management of human trafficking victims in the emergency department . Adv Emerg Nurs J . 2017 ; 39 : 31 – 51 .
- Wolfe DS , Greeson JKP , Wash S , Treglia D . Human Trafficking Prevalence and Child Welfare Risk Factors Among Homeless Youth: A Multi-City Study . Philadelphia, PA : University of Pennsylvania , 2018 . Accessed July 5, 2020. Available from: https://www.covenanthouse.org/sites/default/files/inline-files/Field%20Center%20Full%20Report%20on%20Human%20Trafficking%20Prevalence.pdf .
- Murphy L. Labor and Sex Trafficking Among Homeless Youth . New Orleans : Loyola University , 2016 . Accessed September 29, 2020. Available from: https://www.covenanthouse.org/sites/default/files/inline-files/Loyola%20Multi-City%20Executive%20Summary%20FINAL.pdf .
- Siskin A , Wyler LS . Trafficking in persons: U.S. policy and issues for Congress . Washington, DC . February 13, 2013 . Accessed September 29, 2020. Available from: https://fas.org/sgp/crs/row/RL34317.pdf .
- Sanchez R , Stark S . The hard truth about human trafficking . Nurs Manage . 2014 ; 45 : 18 – 23 .
- Trafficking in Persons Report . U.S. Department of State ; June, 2020 . 570 p. Report No. 20. Accessed September 29, 2020. Available from: https://www.state.gov/wp-content/uploads/2020/06/2020-TIP-Report-Complete-062420-FINAL.pdf .
- Freeman R. The brain can work against abuse victims–the hidden ties to toxic partners . Psychology Today . January 18, 2017 . Accessed September 29, 2020. Available from: https://www.psychologytoday.com/us/blog/neurosagacity/201701/the-brain-can-work-against-abuse-victims .
- U.S. Department of Homeland Security: Blue Campaign . Hidden in Plain Sight: ICE's Work to Combat Human Trafficking . 2013 . Accessed June 6, 2020. Available from: https://www.dhs.gov/blog/2013/01/11/hidden-plain-sight .
- Wyatt T , Sinutko J . Hidden in plain sight: a guide to human trafficking for home healthcare clinicians . Home Healthc Now . 2018 ; 36 : 282 – 8 .
- Alpert E , Ahn R , Albright E , Purcell G , Burke T , Macias-Konstantopoulos W. Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting . Waltham, MA : MGH Human Trafficking Initiative, Division of Global Health and Human Rights : Committee on Violence Intervention and Prevention, Massachusetts Medical Society. 2014 . Accessed September 29, 2020. Available from: http://www.massmed.org/Patient-Care/Health-Topics/Violence-Prevention-and-Intervention/Human-Trafficking-(pdf)/ .
- Tattoos of Human Trafficking Victims. NAPNAP Partners . Napnappartners.org . 2020 . Accessed July 31, 2020. Available from: https://www.napnappartners.org/tattoos-human-trafficking-victims .
- What Is Human Trafficking? DHS Blue Campaign . 2020 . Accessed July 31, 2020. Available from: https://www.dhs.gov/blue-campaign/what-human-trafficking .
- Contreras M , Scroggins H . Informatics Application for the Universal Screening of Intimate Partner Violence and Human Trafficking, in person communication, November 14 , 2019 . Presentation at Tarrant County Public Health Seminar, Fort Worth, TX .
- Hemmings S , Jakobowitz S , Abas M , et al. Responding to the health needs of survivors of human trafficking: a systematic review . BMC Health Services Res . 2016 ; 16 : 320 .
- HEAL Trafficking and Hope for Justice's Protocol Toolkit . HEAL Trafficking: Health, Education, Advocacy, Linkage. 2020 . Accessed July 31, 2020. Available from: https://healtrafficking.org/2017/06/new-heal-trafficking-and-hope-for-justices-protocol-toolkit-for-developing-a-response-to-victims-of-human-trafficking-in-health-care-settings/ .
- Stoklosa H , Lyman M , Bohnert C , Mittel O . Medical education and human trafficking: using simulation . Med Educ Online . 2017 ; 22 : 1412746 .
- SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach . Publications and Digital Products. Store.samhsa.gov . Accessed July 31, 2020 . Available from: https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884 .
- Center for Health Care Services . What is Trauma-Informed Care? Trauma-Informed Care Implementation Resource Center . 2020 . Accessed July 31, 2020. Available from: https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/ .
- Adult Human Trafficking Screening Tool and Guide . 2018 . Accessed July 31, 2020. Available from: https://nhttac.acf.hhs.gov/sites/default/files/2018-07/adult -human-trafficking screening-tool-and-guide.pdf.
- Chisolm-Straker M , Sze J , Einbond J , White J , Stoklosa H . Screening for human trafficking among homeless young adults . Children and Youth Services Rev . 2019 ; 98 : 72 – 79 .
- Department of Homeland Security: Blue Campaign . Trafficking vs Smuggling and Trafficking Indicators . 2020 . Accessed July 31, 2020. Available from: https://www.dhs.gov/sites/default/files/publications/blue-campaign/materials/indicator-cards/bc-indicator-card-english.pdf .
- Department of Homeland Security: Blue Campaign . First Responders Tip Card . 2020 . Accessed July 31, 2020. Available from: https://www.dhs.gov/sites/default/files/publications/blue-campaign/materials/tip-card-first-responders/bc-tip-card-first-responders-english.pdf .
- Identifying Victims of Human Trafficking . Humantraffickinghotline.org . 2020 . Accessed July 31, 2020. Available from: https://humantraffickinghotline.org/sites/default/files/What%20to%20Look%20for%20during%20a%20Medical%20Exam%20-%20FINAL%20-%202-16-16_0.pdf .
- What is Human Trafficking . U.S. Department of Homeland Security Blue Campaign Document Library. 2020 . Available from: https://www.dhs.gov/blue-campaign/tools . Accessed March 22, 2021.
- What you need to know: sex trafficking and sexual exploitation–a training tool for health care providers . Socialwork.asu.edu . 2020 . Accessed July 31, 2020. Available from: https://socialwork.asu.edu/sites/default/files/Sex%20Trafficking%20ASU%20Health%20Care%20Brochure.pdf .
- Egyud A , Stephens K , Swanson-Bierman B , DiCuccio M , Whiteman K . Implementation of human trafficking education and treatment algorithm in the emergency department . J Emerg Nurs . 2017 ; 43 : 526 – 31 .
- Human trafficking, mental illness, and addiction: avoiding diagnostic overshadowing . AMA J Ethics . 2017 ; 19 : 23 – 34 .
- Leopardi N , Hovde A , Kullmann L . The intersection of child trafficking and health care . Pediatr Clin North Am . 2020 ; 67 : 413 – 23 .
- Barriers That Prevent Identification . National Human Trafficking Training and Technical Assistance Center . Nhttac.acf.hhs.gov . 2020. Accessed July 31, 2020. Available from: https://nhttac.acf.hhs.gov/soar/eguide/observe/Barriers_to_Screening_and_Responding .
- Language Identification Guide . 2020 . Accessed July 31, 2020. Available from: https://www.dhs.gov/sites/default/files/publications/blue-campaign/materials/posters/bc-poster-18x24-ispeak.pdf .
- Sexual Assault Nurse Examiner–International Association of Forensic Nurses . Forensicnurses.org . 2020 . Accessed July 31, 2020. Available from: https://www.forensicnurses.org/page/aboutSANE .
- Anti-Trafficking in Persons Programs. Office of Refugee Resettlement ACF . 2020 . Accessed July 31, 2020. Available from: https://www.acf.hhs.gov/orr/programs/anti-trafficking/about .
- Tiller J , Reynolds S . Human trafficking in the emergency department: improving our response to a vulnerable population . West J Emerg Med . 2020 ; 21 : 549 – 44 .
- Human Trafficking is Happening Now . 2020 . Accessed July 31, 2020. Available from: https://www.dhs.gov/sites/default/files/publications/blue-campaign/key-tag-cards/bc-ktceng.pdf .
- Human Trafficking State Laws . Ncsl.org . 2020 . Accessed July 31, 2020. Available from: https://www.ncsl.org/research/civil-and-criminal-justice/human-trafficking-laws.aspx .
-
Atkinson H
,
Curnin K
,
Hanson N
.
U.S. state laws addressing human trafficking: education of and mandatory reporting by health care providers and other professionals
.
J Hum Trafficking
.
2016
;
2
:
111
–
138
.
10.1080/23322705.2016.1175885 Google Scholar
- Mandatory Reporters of Child Abuse and Neglect . Childwelfare.gov . 2019 . Accessed July 31, 2020. Available from: https://www.childwelfare.gov/pubPDFs/manda.pdf .
- Kerr PL , Dash R . Ethical considerations in mandatory disclosure of data acquired while caring for human trafficking survivors . AMA J Ethics . 2017 ; 19 : 45 – 53 .
- When does the Privacy Rule allow covered entities to disclose information to law enforcement . HHS.gov . Accessed July 31, 2020 . Available from: https://www.hhs.gov/hipaa/for-professionals/faq/505/what-does-the-privacy-rule-allow-covered-entities-to-disclose-to-law-enforcement-officials/index.html .
-
Powell C
,
Asbill M
,
Brew S
,
Stoklosa H
.
Human trafficking and HIPAA: what the health care professional needs to know
.
J Hum Trafficking
.
2017
;
4
:
105
–
13
.
10.1080/23322705.2017.1285613 Google Scholar
- Health Management , Ethics and Research Module: 7. Principles of Healthcare Ethics. The Open University . 2020 . Accessed July 31, 2020. Available from: https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=225&printable=1 .
- English A. Mandatory reporting of human trafficking: potential benefits and risks of harm . AMA J Ethics . 2017 ; 19 : 54 – 62 .
- Finkel R , Finkel M . The ‘dirty downside’ of global sporting events: focus on human trafficking for sexual exploitation . Pub Health . 2015 ; 129 : 17 – 22 .
- Genesee County Medical Society . Human Trafficking Victim Identification Toolkit for Physicians and other Medical Professionals . Gcms.org . 2020 . Accessed July 31, 2020. Available from: https://gcms.org/Bulletins/2015_10_01%20-%20Human%20Trafficking%20Victim%20Identification%20Toolkit.pdf .
- Alpert E , Ahn R , Albright E , Purcell G , Burke T , Macias-Konstantopoulos W . Human Trafficking Guidebook on Identification, Assessment, and Response in the Healthcare Setting . Massmed.org . 2014 . Accessed July 31, 2020. Available from: http://www.massmed.org/Patient-Care/Health-Topics/Violence-Prevention-and-Intervention/Human-Trafficking-(pdf)/ .
- Pennsylvania Department of Health, Bureau of Emergency Medical Services . Pehsc.org . 2017 . Accessed July 31, 2020. Available from: http://pehsc.org/wp-content/uploads/2014/05/FINAL-2017-BLS-PROTOCOL.pdf .
- Maryland Human Trafficking Medical Screening Protocols . Frederickhealth.org . 2015 . Accessed July 31, 2020. Available from: http://www.frederickhealth.org/documents/PGHC-Medical-Screening-Protocol-FINAL.pdf .
- Arizona State University School of Social Work . Office of Sex Trafficking Intervention Research. What you need to know: Sex trafficking and sexual exploitation–A training tool for EMS providers . Socialwork.asu.edu . 2020 . Accessed July 31, 2020. Available from: https://socialwork.asu.edu/sites/default/files/Sex%20Trafficking%20STIR%20ASU%20EMS%20Brochure%20TRUST.pdf .
-
Gist R
,
Taylor V
.
Occupational and organizational issues in emergency medical services behavioral health
.
J Workplace Behav Health
.
2008
;
23
:
309
–
30
.
10.1080/15555240802243120 Google Scholar
- Hiding in Plain Sight: A First Responder's Guide to Identifying Human Trafficking–The Relief . 2019 . Accessed July 31, 2020. Available from: https://www.lafra.org/hiding-in-plain-sight-a-first-responders-guide-to-identifying-human-trafficking/ .