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Human trafficking is a complex, and often invisible, crime involving the exploitation of people through forced labor, sexual exploitation or domestic servitude. Cases of human trafficking have been reported in all 50 states. According to UNICEF, the United States is a source and transit country and is considered one of the top destinations for victims of child trafficking and exploitation.1
Human trafficking does not discriminate, and victims vary in age, race, gender, level of education and socioeconomic background. According to the U.S. Department of Justice, there is no single profile for a victim of human trafficking.2
Hidden in Plain Sight
Victims of human trafficking are often hidden in plain sight, which makes it critical for first responders to understand the signs, which can be vague and nonspecific, thus enabling them to intervene effectively.
Because EMS providers have access to victims in vulnerable moments, they are uniquely positioned to assist in identifying at-risk patients and potential victims.
The Trafficking Victims Protection Act of 2000 made human trafficking a federal crime in the United States. It defined human trafficking as a crime involving a person for the purpose of labor or a commercial sex act through the use of force, fraud, or coercion.
The Polaris Project is a non-profit, non-governmental agency developed to help combat human trafficking. They operate the National Human Trafficking Hotline, which is answered 24 hours a day, that victims can call for help.
Victims of human trafficking are often in front of our eyes; however, identifying them can be challenging. Victims will often display subtle signs that can alert observant responders.
These can include
- Behavioral signs: Your patient appears anxious, avoids eye contact or seems unusually submissive. Victims of human trafficking are often mentally traumatized and manipulated.
- Your patient has no identification. Traffickers will frequently hold onto their victims’ driver’s license, passports, or other forms of identification.
- Your patient seems unaware of their location. Sex trafficking victims are frequently moved from city to city, sometimes multiple times a day, so it is not abnormal for them to be unaware of the city they are currently in.
- Your patient is escorted or monitored by another person. They may even look to that other person to answer questions for them. If they do not speak English, their trafficker may be translating for them.
- Your patient has inconsistencies in their story.
- Your patient is called by a name other than their legal name.
- Your patient may have scars, branding, or mutilations in various places on the body.
- Your patient presents with one or more untreated infections.
- You may see bruises or wounds in various stages of healing on your patient.
- Your patient appears malnourished or appears to have poor dental hygiene.
- Your patient seems to have a general lack of healthcare.
Physical Signs of Sex Trafficking
- Frequent urinary tract infections.
- Complaints of pelvic pain.
- Rectal trauma.
- Pregnancy.
- Branding or tattoos in places that are not hidden on the body. These can be found in places like your patient’s neck, chest, or arms. Traffickers will occasionally tattoo or brand their victims to show ownership.
Victims of human trafficking often experience deep psychological trauma, making it crucial for responders to use a trauma-informed approach. This approach emphasizes empathy, respect for boundaries, and avoiding re-traumatizing the victim.
If you encounter a potential victim, keep the following in mind
- Your patient may not know they are a victim. Sometimes a person is unaware that they are a victim of human trafficking before they can be free of the situation. Be careful with your wording when speaking with a potential victim. Their trafficker could be someone that they love and care about and they might not respond well to words like, “perpetrator,” or “abuser.”
- Your patient may have been very psychologically manipulated. Traffickers go to great lengths to manipulate their victims; psychological torture is not uncommon.
- 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.
- Your patient may be embarrassed that they are in this situation and may blame themselves.
- Your patient may or may not show signs of physical abuse
What to Do Next
Ensuring that your EMS agency has a plan for where to transport victims of human trafficking is important. If you suspect your patient is a victim of human trafficking, it is imperative that you transport to a hospital with an onsite social worker.
Notify the charge nurse, physician, and the social worker of your concerns. Refer to your state’s laws regarding law enforcement involvement if your patient has not given you permission to report their situation.
If your service does not already provide human trafficking training, start implementing a training program for all providers. Collaborate with law enforcement, health care professionals, and social service organizations in your area.
Ensure that you have a coordinated plan for caring for and transporting victims of human trafficking. The Blue Campaign is a national public awareness campaign designed to educate the public on how to recognize signs of human trafficking.
Ongoing education for EMS systems is vital in maintaining awareness among providers. First responders are at the forefront of identifying victims of human trafficking, often during brief but critical encounters.
By understanding the signs, utilizing a trauma informed approach, and coordinating with your local resources, EMS can play a pivotal role in identifying victims.
About the Speaker
Suh Hughart is an accomplished paramedic with over a decade of experience working in busy 911 systems. A recipient of the Dr. Larry J. Miller Centre for Emergency Health Sciences Fellowship award, Suh has built a reputation as both a skilled practitioner and educator. She has presented lectures at state, national, and international conferences and has several articles published to her credit. Suh actively contributes to curriculum development and promotes innovative training and education strategies for EMS providers.
References
1. Human Trafficking. UNICEF USA. Accessed 2024 Jan 11. Available from: https://www.unicefusa.org/what-unicef-does/childrens-protection/child-trafficking#
2. What is Human Trafficking? U.S. Department of Justice. Accessed 2024 Jan 11. Available from: https://www.justice.gov/humantrafficking/what-is-human-trafficking
Resources
Allies Against Slavery
International Labor Organization
K.W., personal communication, December 6, 2018.
Polaris Project
R.B., personal communication, July 5, 2019.
Blue Campaign
