Ellen LoCascio, RN, BSN, CEN, knew something was amiss when a female patient said she was 24 years old and the middle-aged man accompanying her was her spouse. The girl looked about 15, and the pair lacked any signs of intimacy typical for married couples. The girl had come to an ED at a hospital in Southwest Florida four years ago because she was suffering from abdominal pain, but strangely, she was cheerful and chatty — as if she were playing a role, according to LoCascio. Then the couple disappeared before LoCascio could return to the room with the discharge papers.
In hindsight, LoCascio suspects the girl may have been a victim of human trafficking. At the time, it seemed hard to imagine this type of abuse was a problem in the U.S. But a second similar incident motivated LoCascio to start asking nurse and law enforcement experts about the issue.
According to the United Nations, human trafficking involves an act of recruiting, transporting, transferring, harboring or receiving a person through the use of force, coercion or other means for the purpose of exploiting them. Data from a 2011 report from the Bureau of Justice Statistics suggests this modern-day form of slavery is thriving in the U.S. According to the report, federally funded task forces opened cases investigating more than 2,500 suspected incidents of human trafficking between January 2008 and June 2010, and about 82% of these incidents were classified as sex trafficking. Florida and Texas are among the top four states in the nation with the highest number of reports regarding potential cases of human trafficking, according to 2011 data from the National Human Trafficking Resource Center, based on the number of calls to its hotline.
Although it may seem difficult to help victims who often are hidden from the public eye, these people may surface when they seek medical treatment. “The most important thing is be aware that human trafficking exists,” said Lisa Creamer, RN, BSN, assistant director of Child Abuse Pediatrics at Texas Childrens Hospital in Houston, Texas. “If you dont recognize that it exists, you wont recognize it when you see the signs. As nurses, we can ask questions and watch for behaviors that give us clues that someone is being forced to do something they dont want to do.”
Though a victim of human trafficking may come to the ED for a variety of reasons, some of the most common are for treatment of sexually transmitted diseases or infectious diseases, said Patricia Crane, RN, MSN, PhD, WHNP-BC, an assistant professor at the University of Texas Medical Branch School of Nursing in Galveston. Crane educates healthcare providers nationally and internationally about how to identify and help victims of human trafficking. Infectious diseases are common because many of the victims are trapped in unsanitary, crowded living conditions, she said.
“Some of the signs to watch for are people who cannot answer the questions you ask, have no drivers license or wallet and cannot be separated from the person with them,” Crane said. “Its also a red flag if you keep asking the patient questions but the person with them answers.”
LoCascio, an ICU and ED nurse in the Lee Memorial Health System in Florida, believes it is critical for nurses to use their assessment skills to discern whether the story matches reality. “The Tanner Staging method can help nurses determine whether a patients stated age is consistent with observed physical findings,” she said. “Be observant about the dynamics between the patient and caregiver. Watch for a lack of concern for the patient that one would not expect from a family or support person.”
When nurses suspect they might be treating a victim of human trafficking, one of the first barriers to overcome is separating the patient from the trafficker in the room, said Rita Hall, RN, MSN, SANE-A, SANE-P, ARNP, a clinical supervisor at the Crisis Center of Tampa Bay. “I might walk her to the bathroom alone, and that could give me a few seconds to ask her if she feels safe with the person who brought her or if anyone is forcing her to do things she doesnt want to do,” Hall said.
It also is important for nurses to notify the physician and social worker, LoCascio said. “Notify the provider about your suspicions because the doctor may have advanced skills to ascertain more information, and sometimes your suspicion alone might trigger another caregiver to go through a chart and find other clues.”
While some victims may want help from medical caregivers, there also are many cases in which the victims do not want to change their situation, said Crane. She remembers a young woman in Texas who suffered from vaginal bleeding and infection because of long hours of sex work every day. She received free surgery for vaginal and anal tissue damage, and the staff at the hospital offered to help her escape her situation, but she would not reveal who the trafficker was. Within three weeks she returned to the trafficker, Crane said.
“For nurses, it is important to understand that it is not about us controlling the situation, but about helping people see that there is a way to get out when they are ready,” Crane said. “These people are captives and feel controlled, so it is a slow process of building trust, and it may not happen in one visit. Let them know that they can come back.”