Victims often have psychological problems such as anxiety, depression, and PTSD. Be vigilant to notice characteristics commonly found in victims, such as a history of running away multiple times or having been placed in many foster homes. Sex slavery victims may use street slang or present with an older “boyfriend.” They may be missing school.⁵

Providers may detect sex-trafficking victims by noticing inappropriate attire or the presence of a “branding” tattoo of a pimp’s name. Victims often use illicit drugs. Pimps will get their victims addicted to drugs to have more power over them, and trafficking victims may use drugs as a coping mechanism. Victims may have a history of many ED visits.

Victims may have a wide range of physical ailments including STIs/pelvic pain, traumatic injuries/bruises, malnutrition, and poor hygiene. They may appear hypervigilant or, alternatively, exhausted.⁶ They may answer many calls or texts during their visit.

Calm, open-ended questioning is key at the start of the social-history interview and will help build rapport with a patient. Her response will depend on the your attitude toward her. Avoid questions starting with “Have you ever… ” because the answer will be “no,” and you will have lost an opportunity. You may ask the patient where she lives and who takes care of her, how she met her “boyfriend,” or whether she must contribute money to her family. You may suggest, “Tell me about your tattoo.” Later in the interview, it may be appropriate to ask her if her body has been used for money, whether anyone has posted photos of her on the Internet, or if she is forced to have sex with men she doesn’t want to have sex with.⁵

When it comes to offering services to the patient, having a plan/protocol in place specific to the needs and safety of this population within your ED is essential. A multidisciplinary approach employing law enforcement, social work, nursing, and hospital administration is needed.⁷ Identifying best practices and developing efficient, user-friendly protocols and comprehensive aftercare options are desperately needed.

Ms. Munoz is a practicing lead nurse practitioner with EMP on Oahu. She has spent the past five years working in the arena of human trafficking. She is currently the volunteer director for the Courage House Hawaii project, whose goal is to build a long-term residential home for underage victims of sex trafficking in Hawaii. Contact Ms. Munoz at jessica.munoz@hoolanapua.org.

References

1. National Center for Missing and Exploited Children. Missing children statistics. 2009. Available at: www.missingkids.com.
2. Polaris Project. Human trafficking resources for the service provider. 2012. Available at: www.polarisproject.org. Accessed April 4, 2012.
3. Shared Hope International. Human trafficking–demand. 2009. Available at: www.sharedhope.org.
4. Farley M. Human trafficking and prostitution. 2013. Available at: www.prostitutionresearch.com.
5. Cooper S, Estes R, Giardino A, Kellogg N, Vieth V. Child Sexual Exploitation Quick Reference. St. Louis, Mo: GW Medical Publishing Inc.; 2007.
6. Zimmerman C, Yun K, Watts C, et al. The health risks and consequences of trafficking in women and adolescents: findings from a European study. London School of Hygiene & Tropical Medicine and the Daphne Program of the European Commission: London. 2003.
7. Hodge D. Sexual trafficking in the United States: a domestic problem with transnational dimensions. Soc Work. 2008;53:143-152.