In the ED

This portion of the website is specifically designed for clinicians currently seeing a patient for whom they are concerned about labor and/or sex trafficking. Clinicians can use their experience, the knowledge of their colleagues and this page to consider whether a patient may be a trafficking survivor. 

 
 
 
 

1. Examples of Populations at Risk in the U.S.

  • U.S. citizens and residents

  • Documented and undocumented immigrants

  • Children in foster homes or institutions

  • Children that have run away from or been kicked out of home

  • Homeless young adults

  • Workers in:

    • Domestic servitude (e.g., housekeeper work and child care)

    • Restaurant industry

    • Nail salon industry

    • Hotel housekeeping industry

    • Manual labor:

      • Factory industries

      • Construction industry

      • Landscape or agricultural industry

    • Illicit drug sales

    • Commercial sex industry

      • Anyone less than 18 years doing sex work is considered a trafficking survivor under federal law

 
 

2. Examples of Signs & Symptoms

  • The patients' lack of knowledge of a given community/whereabouts (e.g., does not know how to get home)

  • The patient is not in control of personal identification (e.g., passport)

  • The patient has few to no personal possessions

  • The patient is inappropriately dressed for weather and/or age

  • The patient does not speak, but understands the clinical team

  • A third party insists on being present and/or interpreting

  • The patient has injuries/signs of physical trauma

  • The patient shows signs of malnourishment

  • The patient has evidence of branding

  • The patient or visitor relays an inconsistent or mechanistically implausible story

  • The patient is less than 18 years and working in the sex industry (this is trafficking, regardless of third-party involvement)

  • The patient has had multiple or frequent STIs

  • The patient has had multiple UTIs and or yeast infections

  • The patient displays an inappropriate or unexpected affect (e.g.: fearful, anxious, submissive, flat affect, hostile)

 
 

3. Examples of Differential Diagnoses

  • Labor law violation

  • Abuse of a vulnerable population

  • Elder abuse

  • Child maltreatment

  • Intimate partner or domestic violence

  • Sexual assault

 
 

4. Treatment Recommendations

  • Always provide high quality, evidence-based medicine first.

  • Speak with and/or examine the patient alone (use a certified medical interpreter and/or hospital staff chaperone when necessary).

  • Specifically ask about the patient’s safety at home and work.

  • Stay calm.

  • Use your institution’s anti-trafficking protocol.

  • If the patient is not ready leave their situation, make an ED-follow up plan

  • Use harm-reduction and patient-centered principles to develop a safe discharge plan.

  • For sexually exploited trafficked patients, clinicians should offer presumptive treatment for:

    • Gonorrhea

    • Chlamydia

    • Trichomoniasis

    • Syphilis

    • UTI

  • If the patient would like to be connected to anti-trafficking services and you do not know your local anti-trafficking organizations, you can call 1.888.373.7888 or visit the National Human Trafficking Hotline’s Resource Directory.