Saving victims hiding in plain sight: Why nurses need mandatory training in human trafficking
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The numbers are appalling. According to estimates from the International Labour Organization, 21 million people worldwide are trapped in human trafficking and forced labor. That’s more than the entire populations of New York, Los Angeles, Chicago, Houston, Philadelphia and Dallas combined.

These are men, women and children who are subjected to brutal forced labor and commercial sex trafficking, often traded and sold as slaves. It’s an especially cruel existence that rips families apart and robs human beings of freedom and dignity — not just in distant foreign countries, but also in cities and towns all across America.

Calling it “one of the most tragic human rights issues of our time,” the U.S. State Department released its annual report on human trafficking last week, urging governments in all nations and at every level to take steps to hold those who participate in human trafficking criminally responsible.

While the State Department is focused on tougher laws to stop human trafficking offenders, we also need to take steps to better identify its victims.

As president of the Emergency Nurses Association, I am calling for nationally consistent policies and clear protocols for identifying victims of human trafficking, and mandatory training of all emergency department personnel.

Those who work in healthcare, particularly in emergency departments, often encounter human trafficking victims. Yet, according to a 2014 study in the Annals of Health Law, healthcare workers are woefully unprepared to identify them.

Researchers surveyed hundreds of victims and survivors of human trafficking and found that 88 percent of them received some kind of medical treatment while held captive, and 63 percent had been treated in an emergency department. Unfortunately, most victims go unnoticed. They are treated for symptoms that prompted them to seek medical care, but are then unwittingly released back into the hands of their captors.

I know, because I unknowingly crossed paths with a victim. Late one night I was treating a young girl in the emergency department who rolled up her sleeve so I could take her blood pressure. I noticed a barcode inked on her forearm, identical to those you see on everyday items in the store. What I didn’t notice was her subtle cry for help. When she saw me looking at the barcode she looked at me and said “I didn’t mean to give you that arm,” then she offered me the other. She was trying to give me a sign but I simply had no idea what was happening.

That’s why I believe we need to engage organizations like The Joint Commission, which accredits and certifies more than 21,000 healthcare organizations and programs in the United States, to help establish consistent protocols to better identify who might be a victim of human trafficking, how to intervene and when. Some states have taken steps to do just that.

Florida and Michigan now require human trafficking training as part of their healthcare licensing processes and in Ohio anyone applying for a commercial driver’s license must go through education in human trafficking. The Association of Flight Attendants is offering training for its members, as is the US Army.

While all of those organizations are taking steps in the right direction, the one thing missing is consistency. Helping these victims requires a deep understanding of the dynamics of their situation. There are physical clues, like certain scars, markings or tattoos like the barcode I saw.

There are verbal clues in the terminology victims will use and there are symptoms and conditions like physical or sexual trauma, depression or suicidal attempts that should always warrant investigation into the possibility of human trafficking.

It’s important to remember, however, that their captors exert powerful physical, psychological and emotional control over victims, and attempting inappropriate interventions at the wrong stage of captivity may be harmful.

That’s why we also need consistent guidelines and mandatory training. Healthcare professionals are in a unique position to help identify and rescue victims, but we need to become proficient at identifying the signs.

To help educate nurses on identifying human trafficking victims, we will have multiple educational sessions on human trafficking at our Emergency Nursing 2017 conference September 13 - 16 in St. Louis, Mo. Sessions include “Human Trafficking in the Emergency Department: Navigating Medical Forensic Protocols,” “Sex Trafficking: It's Near You,” “See, Pull, Cut the Threads of Violence” and “In an ED Near You: Victims of Human Trafficking.”

Positive change can happen. In a new study published in the Journal of Emergency Nursing, a level two trauma center in southwest Pennsylvania implemented a program to identify and rescue victims of human trafficking, where none had ever been identified before.

Through formal education and training of their staff, new screening tools and the establishment of specific treatment protocols, this trauma center identified 38 potential victims in just five months, approximately 20 percent of whom accepted rescue from their situations.

It’s troubling to think that this could happen in our community, that on our streets and in our neighborhoods, people are being held captive in plain view. But it is happening, and the only way we can help save the victims of human trafficking is to first know who they are. 

Karen Wiley, MSN, RN is the president of the Emergency Nurses Association.

The views expressed by contributors are their own and are not the views of The Hill.