Look Beneath the Surface of Human Trafficking in America

The photo shows a woman with her head down behind a fence.
Education and awareness can be the best tools you can use to combat human trafficking. (Photo/Melvin C. Strong, Jr)

When you hear the words “human trafficking,” what is the first thing to come to mind? Is it “Jeffery Epstein?” Is it, “crime against humanity?” Or maybe it’s “child sex,” or “modern day slavery.” Whatever your thoughts may be, the words “human trafficking” are becoming more and more common.

Between social and news media outlets, there are a growing number of stories regarding human trafficking all around the world. While it is easy to think that human trafficking is something that happens in other countries or in large glamorized events, the reality is that human trafficking is grimmer. Human trafficking can indeed be considered a crime against humanity and if you do not know what you’re looking for, human trafficking will happen right under your nose, yet hidden in plain sight. The International Labor Organization estimates that there are hundreds of thousands of victims of human trafficking in the United States.

More from the author: Hidden in Plain Sight

The Trafficking Victims Protection Act of 2000 made human trafficking a federal crime. It defined human trafficking as a person induced to preform labor or a commercial sex act through the means of force, fraud or coercion. Anyone under the age of 18 that is involved in a commercial sex act is also considered a victim of human trafficking, whether force, fraud, or coercion were ever present.

How much do you know about signs of human trafficking? Let’s use Netflix’s Tiger King as an example. Did you notice any of the signs of human trafficking while you were watching the show? There was labor exploitation with workers who reported only being paid $100 a week. Joe would even receive tips about people who were dropped off at the bus station and felt like they had no other option but to work for him. He offered them a place to live in exchange for work. Workers reported that they were paid $150/week for working 10- to 12-hour days. Does any of this information want to make you re-watch Tiger King to search for signs of human trafficking or labor exploitation?

Cases of human trafficking in the United States have occurred in all 50 states, and there is no single profile for trafficking victims. Victims come from diverse socio-economic backgrounds, have varied levels of education and can be from a foreign country or from the United States. However, there are risk factors that can lead to higher susceptibility including: homeless youths, runaways, victims of prior physical or sexual abuse and victims of an economic crisis.

Victims of sex and labor trafficking do share a commonality. The have a need, and it is that need that traffickers exploit. With COVID-19 and our national economic crisis, this is the first time that I can think of where an entire population of people can be placed into the “at risk” category.

We, as medical professionals, are taught to evaluate and assess patients’ illnesses or injuries, then treat accordingly. So how does any of this really pertain to us? A 2014 study by Lederer & Wetzel revealed that 87.8% of all human trafficking victims accessed healthcare services while they were being trafficked. They also revealed that 63.3% of all human trafficking victims accessed emergency departments while they were being trafficked.2

The Polaris Project is a non-profit, non-governmental agency that was developed to combat human trafficking. One of the numerous programs they operate is the National Human Trafficking Hotline. This is a 24-hour hotline that victims can call for help or that citizens use to report human trafficking. Although they also receive calls from sources that do not reveal cases of human trafficking, they have played a critical role in the fight against human trafficking.

According to the Polaris Project 2019 Data Report, there were over 11,000 situations involving human trafficking in 2019, with a 19% increase in contact from individual victims and survivors. They also operate a text line and an online chat.1 In 2019, the U.S. Department of State reported “national human trafficking hotlines, or helplines, are critical components of a comprehensive anti-trafficking response and can be a powerful instrument in combating human trafficking.”

So, how does EMS respond to this and evaluate appropriately? Victims of sex and labor trafficking are commonly right in front of us; we just don’t know how to identify them. Here are some indicators that your patient could be a victim of human trafficking.

  1. Your patient has no identification. It is common for traffickers to hold onto the victims’ driver’s license, passports, or other forms of identification.6
  2. Your patient is unsure of their whereabouts. Sex trafficking victims are commonly moved from city to city, sometimes multiple times a day, so it is not uncommon for them to be unaware of the city they are currently in.5
  3. Your patient is escorted or monitored by another person. They may even look to that person to answer questions for them. If they do not speak English, their trafficker may be translating for them.5
  4. Your patient has inconsistencies in their story.
  5. Your patient is called by a name other than their legal name.4
  6. Your patient may have scars or mutilations in various places on the body.7
  7. Your patient presents with one or more untreated infections.7
  8. You may see bruises or wounds in various stages of healing on your patient.7
  9. Your patient appears malnourished.7
  10. Your patient appears to have poor dental hygiene.
  11. Your patient seems to have a general lack of healthcare.7

Some physical signs of sex trafficking can include:

  1. Frequent urinary tract infections.
  2. Complaints of pelvic pain.
  3. Rectal trauma
  4. Pregnancy
  5. Branding or tattoos in places that are not hidden on the body. Sometimes traffickers will tattoo or brand their victims to show ownership.5

In EMT school, we are taught to be medical detectives. We are taught to ask questions, then ask more questions. We are taught to dig deeper into patient’s stories to get better insight into their complaint. Last year, I had the opportunity to interview a victim of human trafficking who commonly had contact with medical professionals. She advised me that her trafficker would give her a scripted story for whenever she would walk into a clinic. Possibly due to long working hours, she — and other trafficked girls — would often become sick. If the clinic asked her what she did for a living she would tell them she was a waitress at a restaurant, as her trafficker scripted her to do. She said that had anyone asked her details about her story, she would not have known what to say and that someone may have suspected that something was wrong. But her story was taken at face value; no one ever questioned her.

What if you do encounter a victim? Are you aware of how they may act? There are some issues that you should be aware of if you do encounter a victim of human trafficking:

  1. Your patient may not know they are a victim. Sometimes a person is unaware that they are a victim of human trafficking until they are free of the situation. Be careful with your wording when speaking with a potential victim.
  2. Your patient may have been psychologically manipulated. Traffickers go to great lengths to manipulate their victims and commonly they are psychologically tortured.
  3. Certain wording can make a victim shut down. If the victim is being trafficked by a person they love, such as their significant other, spouse, or other family member, they may take offense to words like “perpetrator” or “abuser.” They may even have a “Stockholm Syndrome” type of bond with their trafficker.
  4. Your patient may be embarrassed that they are in this situation and may blame themselves.
  5. Your patient may or may not show signs of physical abuse.

Remember that traffickers often use psychological manipulation to maintain control of victims. In an interview, the human trafficking victim-witness coordinator for Central Texas told me a story about how a trafficker from Austin kept his victims in line. She advised me that one night he took his victims onto an overpass and had them stand on top of the guardrail. He then showed them what would happen if any of them ran or sought help by pushing one of them off the bridge to her death. He sacrificed one victim to keep the rest of his victims in line.

If you suspect that your patient is a victim of human trafficking, what do you do? It is important to safely separate your patient from anyone who may be with them. Remember that traffickers utilize manipulative methods to control their victims and you want your patient, the potential victim, to know they are in a safe environment. If they do not speak English, there is a possibility that their trafficker is translating for them, and if you do not speak their language you cannot be sure of what is actually being said. You can attempt to utilize translation applications on your cell phone for translation. And you can explain to whomever is trying to accompany the patient, that the hospital has medical translators for such instances.

Taking your patient to a hospital with an on-site social worker is imperative.5 Your patient, the potential victim, needs to have someone to advocate for them as soon as you enter the emergency department. Communicate your concerns to the on duty social worker, the charge nurse and the doctor assuming care of your patient. Refer to your state laws regarding law enforcement involvement if your patient has not given you permission to report their situation.

Education and awareness can be the best tools you can use to combat human trafficking. The Blue Campaign is a national public awareness campaign designed to educate the public on how to recognize signs of human trafficking. As the awareness of human trafficking continues to spread, it is likely that the number of victims identified will increase. The reality is that we are not going to be able to save everyone, people will always slip through the cracks. But as healthcare providers, when we have contact with over 60% of victims of human trafficking while they are being trafficked; our education, our awareness, and our response are going to be critical. And as people, how can we not feel obligated to try?


  1. 2019 Statistics from the National Human Trafficking Hotline.(n.d.)In Polaris Project. Retrieved September 23,2020, from https://polarisproject.org/wp-content/uploads/2019/09/Polaris-2019-US-National-Human-Trafficking-Hotline-Data-Report.pdf.
  2. Lederer L. and Wetzel C. The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals of Health Law. 2014;23(1):77-78.
  3. 2019 Trafficking in Persons Report. (n.d) In U.S. Department of State. Retrieved September 23, 2020, from https://www.state.gov/reports/2019-trafficking-in-persons-report/.
  4. Bruder, R. (2019, July 5). Personal Interview (Phone Interview).
  5. West. K. (2018, 6 December). Personal Interview (Personal Interview).
  6. Recognizing the Signs.(n.d)In National Human Trafficking Hotline. Retrieved August 1, 2019, from https://humantraffickinghotline.org/human-trafficking/recognizing-signs.
  7. Indicators of Human Trafficking.(n.d.)In U.S. Department of Homeland Security Blue Campaign. Retrieved October 3, 2020, from https://www.dhs.gov/blue-campaign/indicators-human-trafficking.


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