Human Trafficking: Clinical Presentation & Treatment

How to Care for Trafficked Persons in the E.D.
Makini Chisolm-Straker, MSII Brown Medical School, Mt. Sinai School of Medicine 2007

Instructional Goals:
• You will be familiar with the clinical presentation of human trafficking victims in the E.D. in the U.S. • You will be familiar with the appropriate treatment of human trafficking victims. • You will appreciate the role of emergency healthcare practitioners in facilitating the escape of trafficked persons.

Instructional Learning Objective (what you will do by the end of this session): You will know the hotline to call when a suspected trafficking victim presents to the emergency department.

• obtunded teenage ♀, GCS 5 • extensive bleeding from vaginal canal • visible burns, cuts, scars on wrists, ankles, neck • hx of schizophrenia? • bro. concerned about a dangerous abortion attempt

Human Trafficking is:
• the recruitment, transportation, transfer, harboring or receipt of persons: – by the threat or use of kidnapping, force, fraud, deception or coercion, or by the giving or receiving of unlawful payments or benefits – to achieve the consent of a person having control over another person, and – for the purpose of sexual exploitation or forced labor.

Human Trafficking is:

• the illegal use of a variety of means

• to force an individual (the trafficked)
• to relinquish his/her personal freedom

• for the profit of another person (the trafficker). • often, simply considered “involuntary servitude” or “modern-day slavery.”

Types of Trafficking
Sexual Exploitation • prostitution • pornography • bride trafficking • commercial abuse of children • massage parlors, hostess clubs, brothels, escort services, commercial phone sex & internet dating • exotic dancing/stripping

Types of Trafficking
Forced Labor • domestic servitude (domestic work & child care) • manual labor
-small-scale factory work -construction work -sweatshops & farms of multinational corps -agricultural & landscape work

• restaurants • nail salons • hotel housekeeping
• • • • • • false adoption drug trade street begging camel jockeys child soldiers organ harvesting

•15,000 – 60,000 people are trafficked into the U.S. annually •80% of trafficked persons are ♀ & children •U.S. citizens

Trafficking Affects (Populations at Risk):

•U.S. residents
•documented immigrants •undocumented immigrants •youth (esp. runaways) •urban pop.

•suburban pop.

Role of Healthcare Practitioners in the E.D.
• Identify human trafficking victims
• Treat the chief complaint/illness and/or the emergent issue • Offer (& provide, if patient-desired) appropriate treatment for the unsafe environment

Difficulty Identifying Trafficking Victims
• distrust of service providers • lies & false stories • untrustworthy interpreters • “one shot” • difference between intimate partner violence & human trafficking

Signs & Sx
• • • • • • • • lack of knowledge of a given community/whereabouts not in control of personal ID few  no personal possessions does not speak 3rd party insists on being present or interpreting injuries (multiple, old & new) signs of malnourishment branding

Signs & Sx
• • • • • • • • no healthcare under 18 & in sex industry – DE FACTO claim of “just visiting” inconsistent story behavior change when “law enforcement” is mentioned STIs bacterial &/or yeast infxns demeanor (e.g.: fearful, anxious, submissive, flat affect)

What to do
What to do
1. 2. 3. 4. 5. 6. 7. building trust is the number one priority reassure the potential victim one-on-one interactions are ideal specifically ask about the patient’s safety offer reworded stories stay calm & even-keel ALWAYS document your suspicion in your notes, at the very least

8. Call a Help Hotline:

English: 1-866-US-TIPLINE
Korean: 1-888-976-5274 Spanish: 1-888-80-AYUDA

The folks working at the hotlines are trained to know how to help you, but you are their eyes & ears. Trust their knowledge, your experience & your gut. If the patient is an adult, they have the last say, but give them every opportunity to receive help.

Even if a potential victim doesn’t want help, call: 1 - 8 6 6 - U S - T I P L I N E, to report suspected trafficking; the tip can save lives.

Clinical Recommendations*
Presumptive Treatment for: • gonorrhea • chlamydia • trichomoniasis • syphilis • UTI
*for sexually exploited victims

Special thanks to Polaris Project for the images & information. Clinical Recommendations courtesy of Doctors of the World.

For more information on trafficking in the U.S. you can: email: visit: or