Sex trafficking—as defined by the Trafficking Victims Protection Act of 2000—is the “recruiting, harboring, transporting, providing, obtaining, patronizing, or soliciting of an individual through the means of force, fraud, or coercion for the purpose of commercial sex.”¹ In 2020, 7,648 cases of sex trafficking were reported to the National Human Trafficking Hotline, with the highest number of cases noted in California (1,334), Texas (987), Florida (738) and New York (414).²

Health care settings are an important point of access for trafficked persons. In a study of 173 survivors of human trafficking, nearly 70 percent of individuals were seen by a health care worker while being trafficked; the ED is the most frequently accessed of these settings.³ The study sought to describe the health care settings most frequented by victims of human  trafficking. Unfortunately, as many as 90 percent of sex-trafficked persons may go unrecognized by their physicians.⁴ Why do victims so frequently go undetected in the ED? This problem is due in part to medical staff often lacking the necessary training to identify trafficking victims and health care institutions rarely implementing standardized procedures to guide staff on the appropriate actions.

Recognizing Human

Trafficking in the ED

An important first step in improving ED staff’s recognition and response to trafficking is implementing educational interventions. In fact, ACEP’s 2020 Policy Statement on human trafficking recommends that “emergency medical services (EMS), medical schools, and emergency medicine residency curricula should include education and training in recognition, assessment, documentation, and interventions for patients surviving human trafficking” and that “ED and EMS staff receive ongoing training and education in the identification, management, and documentation of human trafficking victims.”⁵ Many studies have shown that various formats—including didactic sessions, online modules, interactive workshops and case-based simulations—effectively increase ED staff’s baseline knowledge of sex trafficking and improve preparedness to identify and assist victims, but are infrequently identified.^6–12 To address this issue, we developed and piloted a training intervention for physicians on human trafficking and how to identify and treat these patients. Included in the intervention participants were emergency medicine residents, ED attendings, ED nurses, and hospital social workers. Prior to the intervention, 4.8 percent felt some degree of confidence in their ability to identify and 7.7 percent to treat a trafficked patient. After the 20-minute intervention, 53.8 percent felt some degree of confidence in their ability to identify and 56.7 percent care for this patient population. Because this problem is global, we created a website that includes an instructive toolkit and an interactive course for self-learning and/or assessment. This intervention will give emergency physicians the tools they need to assess and treat a patient who might be a victim of human trafficking.5 Emergency physicians are on the frontlines of identifying and caring for trafficked persons. However, most emergency providers have never received training on trafficking, and studies report a significant knowledge gap involving this important topic. Workshops often employ a ”train-the-trainer” model to address clinicians’ knowledge gaps involving various topics (including trafficking).