The first responder-the firefighter, EMT, and paramedic-is out in the community and interacting with people every day. They are entering people’s homes, going into warehouses, inspecting restaurants, visiting homeless shelters, trekking into impromptu camps along creeks and rivers, and entering farms and ranches all around the state. First responders are welcomed into places that most people will never go, and may never even know exist. It is a huge responsibility, and the trust coming from the community is a privilege that every first responder should be thankful for. Although they might not always be able to make it to a call in time, they try their best to make sure that you are equipped to handle the emergency until they can arrive. Some first responders offer first aid training on equipment such as the ZOLL AED Plus package to those who are interested in lending a helping hand as a way to give you what you need to help until they arrive. Ultimately, the first responder community honors that trust by making sure that they are treating every patient with whom they interact to the best of their ability and with the utmost respect. Caring for people, after all, is the bottom line of the job.
Human Trafficking and Healthcare
Still, it is becoming increasingly apparent that there is a unique population of people deserving of services that many first responders may not have been trained to recognize: those experiencing the exploitative crime of human trafficking. One recent study that surveyed survivors of trafficking suggests that up to 88% of those experiencing trafficking met at least once with a healthcare professional during their period of exploitation. Yet almost none of them were identified as victims during that interaction with the healthcare system. Of that 88%, the majority reported that they were seen in an Emergency or Urgent Care setting, but General Practitioners, OB/GYNs, and Dentists were also among those specialties that survivors reported accessing. To the best of my knowledge, there have not been any studies performed about how often those experiencing human trafficking come into contact with medical first responders.
In the nine years I have worked as a first responder, I was never once introduced to the crime of human trafficking in trainings, textbooks, or even in conversations with peers. We were, of course, taught to recognize signs and symptoms of abuse, neglect, malnourishment, assault, reproductive health problems, gastrointestinal problems, and a myriad of other ailments that we may encounter. As I gained experience, I began to learn some of the basics of the child welfare, criminal justice, mental health, and overall healthcare systems-yet I still had not heard the term “human trafficking” until I began to investigate it myself. It took a blatantly obvious case of Commercial Sexual Exploitation of a Child (CSEC) before I realized that it happens in the United States, and more specifically in our own state. Human trafficking in Colorado is a reality.
How Healthcare Providers Can Support Identification
First responders can play an important role in the identification of those who may be experiencing human trafficking. They are out in the field and have access to information like the patient’s living situation and can begin to foster the trust in the healthcare system that is necessary for any survivor to feel safe enough to disclose their situation. Yet the nature of first responder work mandates that time spent with somebody is limited-it only takes so long to transport a patient from somewhere to a hospital. This is where having a collaborative approach with other staff in Emergency Rooms is so important. Nurses, physicians, techs, social workers, registration, and even environmental services are integral to the recognition and treatment of those who have experienced trafficking. First responders can pass along their findings and suspicions about human trafficking, but if the receiving facility is unaware of the crime then people may continue to fall through the cracks. They simply will not receive the care that they need and deserve.
- Shares a scripted or inconsistent history
- Is unwilling or hesitant to answer questions about the injury or illness
- Is accompanied by an individual who does not let the patient speak for themselves, refuses to let the patient have privacy, or who interprets for them
- Demonstrates fearful or nervous behavior or avoids eye contact
- Is resistant to assistance or demonstrates hostile behavior
- Evidence of controlling or dominating relationships (excessive concerns about pleasing a family member, romantic partner, or employer)
- Is unable to provide his/her address
- Is not aware of his/her location, the current date, or time
- Is not in possession of his/her identification documents
- Is not in control of his or her own money
- Is not being paid or wages are withheld
Treating Survivors With Care
Identification is not the only task that healthcare providers must perform when interacting with those who have or are experiencing trafficking. Obviously, taking care of acute health needs of the survivor is of utmost importance. Studies have shown that the medical and psychological complaints that cause one experiencing trafficking to present in a healthcare setting is as varied as the crime of human trafficking itself. Nearly without exception, those who have experienced trafficking have suffered from one or more physical or psychological ailments. Treating these symptoms with care and compassion should be any healthcare provider’s first priority. Professionals who do so may foster an interaction that builds rapport with the patient and creates an environment where he/she feels safe enough to either disclose or even exit from their exploitation.
Injuries and Illnesses Experienced by Trafficking Survivors
- Intentional and accidental burns
- Branding, tattoos, and other purposeful and permanent stigmata of “ownership”
- Blunt force trauma
- Firearm and knife wounds
- Strangulation injuries
- Dental and oral cavity injuries
- Traumatic brain injuries
- Neuropathies and other effects of torture
- Scarring, especially from unattended prior injuries
- Rape or gang rape
- Genital trauma
- Repeated unwanted pregnancy
- Forced abortion
- Complications from repeated or poorly performed abortions
- Sexually transmitted infections (e.g., chlamydia, gonorrhea, human papilloma virus, hepatitis B and C, and HIV)
- Pelvic inflammatory
- Dental caries
- Abdominal complaints
- Chronic pain syndromes
- Substance abuse
- Infectious diseases usually prevented through routine immunization
- Other infectious diseases such as tuberculosis, intestinal parasites, and hepatitis
- Chronic back pain from repeated strain or overuse
- Vision and hearing impairment from lack of protective gear
- Skin, nervous system, and respiratory ailments from exposure to industrial or agricultural chemicals
- Effects of prolonged sun, heat, or cold exposure
- Suicidal ideation
- Panic attacks
- Dissociative reaction
- Poor self-esteem/feelings of worthlessness
- Shame and guilt
- Memory loss
Adapted from Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting
A Connection Point to Key Resources
Finally, healthcare providers need to understand that human trafficking is a vastly complicated crime, with the potential for serious and long-term repercussions for those who have experienced it. Being mindful of that, they should know what resources are available in their region for those survivors who have chosen to identify themselves. Referral networks like the Colorado Network to End Human Trafficking (CoNEHT) hotline, managed by LCHT, are great resources for the provider who can sit with their patient and try to meet their needs for things like shelter, safety, or legal representation. They also offer a resource for reporting tips, helping with identification, and offering basic information on human trafficking issues for the curious provider.
Healthcare providers in general, and first responders in particular, are often privy to situations and invited into locations that the general populace is completely unaware of. They are given privileged access to some of the most intimate secrets that their patients have. There is an entirely unique and underserved patient population out there, and one that healthcare providers have the potential to help escape from horrific exploitation and abuse. Being able to recognize the signs and intervene in a way that gives the patient the choice to escape from their situation on their own terms, and helping them to access the services that they need is a space that healthcare providers are uniquely suited to fill. We are all in the business of helping people, let’s make sure we are helping everybody we can. Together, we can end human trafficking in Colorado, and around the world.
Great blog, Brandon. The specifics are helpful and point out how more education is necessary for health professionals.