He denies a history of asthma or tobacco use, and reports that the foreman repeatedly threatened him and accused him of having lied about his health to the recruiter. With more history and diagnostics, you believe the wheezing to be related to chronic pesticide fume exposure without personal protective equipment, and the fatigue to be a combination of heat cramps, malnutrition, and anemia.

Hospital Preparedness: Identifying and Assisting

Human trafficking, whether for forced manual labor or commercial sexual exploitation, is a violent form of modern-day slavery with devastating physical and mental health effects on adults and children.^1,2 The exact prevalence of human trafficking is unknown. However, cases of human trafficking have been reported in all 50 states, and a large proportion of victims are U.S. citizens and lawful residents.³ The U.S. Department of Justice found that among nearly 460 confirmed sex trafficking victims, 83 percent were citizens, and 55 percent were 17 years old or younger (87 percent were 24 years or younger).⁴ Among a cohort of 98 sex trafficking survivors, 87.8 percent reported having been evaluated in a health care facility at least once while exploited, and 63 percent reported seeking care in a hospital ED.⁵

Emergency providers are uniquely positioned to identify and assist trafficking victims. This case highlights the importance of long-established patient-centered care recommendations such as professional language interpretation, private patient interviews, and detailed history-taking and physical examinations. While the multiple red flags here may have been more easily recognized following specialized training, our unconscious biases and assumptions and the demands for our time and attention can interfere with our ability to provide patient-centered care that will foster the trust and sense of safety that trafficking victims need to request help.

To effectively assist these highly traumatized patients, emergency providers must not only receive training on how to recognize human trafficking, but must also be patient-centered in the approach to care, and survivor-centered in response to identification and disclosures.

There are specific steps you can take to enhance your practice and improve identification and assistance of trafficked persons:

1. Go back to basics. Recall why you chose your profession and commit to making your clinical practice more patient-centered. Identify a list of concrete behaviors you wish to incorporate and commit to a reasonable time frame to implement them. These behaviors include:

• Ensuring privacy during examinations.
• Collaborating with professional interpreters.
• Active listening and being fully present in the moment.
• Sharing decision-making with the patient.
• Taking the time to explain diagnoses and treatment options.
• Demonstrating patience and compassion.

2. Seek educational opportunities. Complete an in-person or online educational activity for health care professionals to enhance your knowledge and skills about human trafficking. Consider the content and ensure that it includes information about health impacts, red flags, screening, and responding to an identification or disclosure. The National Human Trafficking Resource Center offers assessment information for physicians.
3. Maintain a high index of suspicion. For patients with multiple red flags, be ready to screen for human trafficking and know your state’s mandatory reporting laws. Even if human trafficking is not a mandated reporting event, the commercial sexual exploitation of children is considered child abuse and may require reporting to local officials.
4. Be prepared to respond. Familiarize yourself with your hospital’s policies and protocols for human trafficking. If no guidelines are in place, identify relevant hospital and community resources; the National Human Trafficking Resource Center can help locate resources in your community. For patients who desire assistance and communicate the possibility of life-threatening danger, consider involving hospital security personnel early on in the examination.
5. Catalyze change through advocacy. Educate hospital administrators, colleagues, and your community about the health impact of human trafficking and how they can assist in developing protocols to safely and effectively respond to trafficked persons presenting to the ED.

The authors are the Chair of the ACEP Trauma and Injury Prevention Section (TIPS) Task Force on Human Trafficking and the Chair of TIPS.