The Critical Role of EMS Professionals in Identifying Human Trafficking
By Daria Mueller, PhD, Thomas Grawey, DO, Paul E. Pepe, MD, MPH, and Benjamin W. Weston, MD, MPH, FAEMS
Human trafficking is a widespread, international problem that has resulted in great harm for individuals, families, communities, and society as a whole. Victims of trafficking experience high rates of physical injury, sexual abuse, behavioral health disorders and many other conditions that inevitably invoke the need for medical care.1
Human trafficking is defined as 1) the exploitation of a person, or persons, for labor, services, or commercial sex, when induced by force, fraud, or coercion, and 2) when a person, not yet 18 years of age, is induced to perform commercial sex acts.2 There is no accepted estimate of the prevalence of human trafficking, either domestically or internationally, due to significant challenges with reporting and identification. However, we do know that trafficking is extensive, has no geographic constraints, and occurs across diverse settings.3
Given their role in both the healthcare system and community at large, EMS providers have unique opportunities to recognize and address human trafficking. Trafficked persons are very likely to see a healthcare provider, predominately in emergency or urgent care settings.4 One study found that 63% of sex-trafficked women in the U.S. reported that they went to an emergency department while being trafficked.5 Unfortunately, trafficking victims rarely volunteer or reveal their circumstances for a variety of reasons (e.g., fear, mistrust, stigma). Additionally, untrained frontline medical providers will not readily recognize potential signs of trafficking without awareness, education, guidance on screening tools, and protocols for reporting and accessing support.6,7
Likewise, EMS providers, who usually have even briefer interactions with trafficking victims, may also fall short on recognition. Yet, EMS crews not only encounter individuals who may present with suggestive injuries or other physical indicators of trafficking, but they may also respond into those environments in which trafficking victims work, live, and engage in commercial sex acts or other coerced activities. Oftentimes, potential victims may be in the presence of their traffickers who can also display clues for suspicious circumstances. With appropriate training, EMS professionals may not only be the first to identify such victims, but they can also facilitate pathways to support. In addition, if a potential victim is transported to the hospital, the educated EMS professional may also have an opportunity to talk privately in a compassionate, sensitive, and non-judgmental manner, engendering trust and a sense of safety.
Accordingly, expert education of EMS professionals with guidance that will increase their ability to recognize and intervene with potential victims of trafficking should become a highly-recommended priority.8-10 The National EMS Advisory Council has already issued recommendations for the development of national educational standards and a helpful toolbox of resources on human trafficking for EMS professionals and 9-1-1 call-takers / dispatchers.8
Donnelly and colleagues have advised that ten training topics should be included in any EMS training and highlighted the need to dispel pervasive myths and stereotypes.11 Florida State University and Arizona State University offer free EMS-specific training materials and the Federal Emergency Management Agency (FEMA) also offers a 45-60 minute online course, complete with a final exam and certification through its Emergency Management Institute. Local trafficking organizations are often able to provide tailored local education to EMS as well.
Adding a trafficking screening tool to EMS treatment guidelines or electronic patient care records is recommended to increase identification of these patients. However, while multiple screening tools are available, few have yet to be rigorously evaluated and most do not apply to all types of trafficking situations or populations.6,12 Nonetheless, they offer a starting point for the types of trust-invoking conversations and questions that EMS should attempt to pose in such circumstances.
Screening tools commonly address the potential victim’s overall appearance and demeanor as well as their work and living conditions. They also evaluate physical health, history of injury and behavioral well-being, while also beginning to (sensitively) address immigration and family situations along with freedom of movement concerns and criminal history.6 However, when selecting a screening tool, one must consider the intended setting in terms of where and under what conditions it may be useful or feasible, as well as its applicability to different types of trafficking populations (e.g., labor, sex, or all forms of human trafficking). In addition, one must consider the amount of time needed to administer the tool, not to mention its effectiveness and validation. No matter which screening tool is chosen, effective screening procedures should always exude a non-judgmental, caring approach that not only facilitates identification of trafficking victims, but also prioritizes their safety, privacy, autonomy, and support for their basic needs.6
Beyond screening, EMS clinicians also need guidance on how to respond once a trafficking victim has been identified. Options include calling the National Human Trafficking Hotline, the confidential sharing of screening and assessment information with emergency department staff, and initiating discussions regarding safety planning.6 Federal law mandates health care providers to report suspected human trafficking of minors, and EMS clinicians should become aware of and follow local laws and policies regarding reporting requirements.13 To better advocate for and connect victims to the applicable resources available in that community, it is also incumbent upon EMS and other healthcare providers to establish collaborative relationships with relevant local organizations, including anti-trafficking coalitions and related victim services agencies.6
In sum, EMS professionals have unique opportunities to identify and support victims of human trafficking. Accordingly, EMS professionals need to have organizational support to receive expert, relevant education, utilize appropriate screening and assessment tools, and develop evidence-based protocols and guidelines for sensitively, discretely, and competently approaching trafficking victims and assisting them with proper referrals and support systems.
References
1. Hemmings, S., et al., Responding to the health needs of survivors of human trafficking: a systematic review. BMC Health Services Research, 2016. 16(1): p. 320.
2. Trafficking Victims Prevention and Protection Reauthorization Act of 2022, in 22 U.S.C. § 7102. 2022: USA.
3. Barrick, K. and R. Pfeffer, Advances in measurement: A scoping review of prior human trafficking prevalence studies and recommendations for future research. Journal of Human Trafficking, 2024. 10(1): p. 1-19.
4. Chisolm-Straker, M., et al., Health care and human trafficking: we are seeing the unseen. Journal of Health Care (for the poor and underserved), 2016. 27(3): p. 1220-1233.
5. Lederer, L.J. and C.A. Wetzel, The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals Health L., 2014. 23: p. 61.
6. Macy, R.J., et al., A scoping review of human trafficking screening and response. Trauma, Violence, & Abuse, 2023. 24(3): p. 1202-1219.
7. Winks, K.M., et al., Frontline medical professionals' ability to recognize and respond to suspected youth sex trafficking. Pediatric Emergency Care, 2023. 39(4): p. 219-225.
8. Human Trafficking Education for EMS Professionals. 2021, National Emergency Medical Services Advisory Council.
9. Charron, C.M., et al., What do EMS professionals know about human trafficking? Assessing the impact of training. Journal of Human Trafficking, 2022. 8(4): p. 451-462.
10. O’Brien, J.E., et al., Medical first responders and child sexual exploitation: Needs, efforts, and next steps. Journal of Human Trafficking, 2022: p. 1-11.
11. Donnelly, E.A., et al., What do EMS professionals know about human trafficking? An exploratory study. Journal of Human Trafficking, 2019. 5(4): p. 325-335.
12. Hainaut, M., et al., Are screening tools for identifying human trafficking victims in health care settings validated? A scoping review. Public Health Reports, 2022. 137(1_suppl): p. 63S-72S.
13. Biesenthal, B., Goodspeed, T., and Cross, T., Human Trafficking and Health Care Providers: Legal Requirements for Reporting and Education. 2022, Jones Day.
ABOUT THE AUTHORS
Daria Mueller, PhD, is a Research Scientist in the Department of Emergency Medicine at the Medical College of Wisconsin.
Thomas Grawey, DO, is assistant professor at the Medical College of Wisconsin and medical director for the City of Kenosha Fire Department.
Paul E. Pepe, MD, MPH, is coordinator of the Metropolitan EMS Medical Directors (aka “Eagles”) Global Alliance, Dallas, Texas.
Benjamin W. Weston, MD, MPH, FAEMS, is associate professor at the Medical College of Wisconsin and chief medical director for the Milwaukee County Office of Emergency Management.
