Unless clinicians have good reason to believe that the patient’s life is in imminent danger, clinicians should always engage the patient in discussion, seek their consent before involving law enforcement, and avoid promising safety. In cases where involvement of outside authorities is mandated by law (ie, state mandatory reporting laws), clinicians should work closely with colleagues from other disciplines (eg, social work, child protection) to ensure the process is as transparent, predictable, and non-retraumatizing as possible.

In some situations, despite the abuse and violence, trafficked persons may not recognize their own exploitation and therefore may not identify with the victim narrative. This is most often the case in sex trafficking when the exploitation is achieved under the guise of romantic seduction rather than more overtly non-relational forms of victimization. In these cases, trafficking can have the appearance of intimate partner violence and may be initially understood as that alone by the exploited person. In addition to mandated reporting when applicable, clinicians should offer to consult social services for a lethality assessment, safety planning, and referral to resources. If a patient declines social work involvement, the clinician should be prepared to perform some of these tasks and recommend the patient returns to the emergency department when they’re ready to receive assistance or go to the nearest police station if the level of danger escalates.

One important resource for clinicians and patients is the 1-888-373-7888 National Human Trafficking Hotline. A patient can be offered a private space in the emergency department to call the hotline, and the clinician can offer to accompany them while making the call. If the patient asks the clinician to make the call on their behalf, the purpose of the call and how much personal information the patient wants revealed should be established first (eg, request for local resources versus assistance). The hotline number can also be provided to the patient for later use, or if a patient fears it being found in their possession, the clinician can help the patient memorize it by noting it may be more easily recalled as 888-3737-888. Patients can also text “HELP” or “INFO” to BeFree (233-733) to reach the hotline, but clinicians should remind patients that smartphones provided to them by the trafficker may be monitored. For greater effectiveness, emergency physicians should become familiar with the local anti-trafficking resources and partner with local law enforcement and other hospital disciplines (eg, addiction, child protection, forensic nurse examiners, social work, security, risk management, legal counsel) in developing a multidisciplinary protocol to facilitate and streamline a trauma-informed, victim-centered response.