Treat and Report

As with any emergency department patient, the priority is to identify and treat all life-, limb-, and organ-threatening issues. The history and physical examination will direct the laboratory and radiographic workup needed. If requested or consented to by the patient, sexual assault evidence collection should be performed early in the emergency department visit. Patients should be tested for sexually transmitted infections and pregnancy, as applicable. Placement for drug and/or alcohol rehabilitation should be considered if indicated. 

According to the revised federal Child Abuse Prevention and Treatment Act, the sexual exploitation of minors is child abuse, and health care professionals are mandated reporters of child abuse. As such, calls should be made to the relevant authorities. As was done in this case, a discussion of the limits of confidentiality should be completed prior to asking questions that may elicit a disclosure.¹¹ 

Departments should develop specific evidence-based policies regarding the evaluation, care, and management of suspected trafficking victims.12 In addition, other resources should be engaged, including local legal aid, social work, victim advocates, and, when appropriate, law enforcement. The National Human Trafficking Hotline (888-373-7888) is available 24 hours a day and can help with assessment, access to shelter, and safety planning. For non-U.S. residents, the Office of Refugee Resettlement of the U.S. Department of Justice can provide refugee status to victims of trafficking.¹³ 

Edited by Hanni Stoklosa, MD, MPH, an emergency physician at Brigham and Women’s Hospital in Boston and executive director and co-founder of HEAL Trafficking.

References

1. Baldwin SB, Eisenman DP, Sayles JN, et al. Identification of human trafficking victims in health care settings. Health Hum Rights. 2011;13(1):E36-49. 
2. Lederer L, Wetzel C. The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Ann Health Law. 2014:23(1):61-91.  
3. Chisolm-Straker M, Baldwin S, Gaïgbé-Togbé B, et al. Health care and human trafficking: we are seeing the unseen. J Health Care Poor Underserved. 2016;27(3):1220-1233. 
4. IOM launches updated counter trafficking data portal with new statistics. International Organization for Migration website. Accessed Dec. 24, 2020.
5. Chaffee T, English A. Sex trafficking of adolescents and young adults in the United States. Curr Opin Obstet Gynecol. 2015;27(5):339-344. 
6. Chisolm‐Straker M, Singer E, Rothman EF, et al. Building RAFT: trafficking screening tool derivation and validation methods. Acad Emerg Med. 2020;27(4):297-304. 
7. Armstrong S. Instruments to identify commercially sexually exploited children: feasibility of use in an emergency department setting. Pediatr Emerg Care. 2017;33(12):794-799. 
8. Stoklosa H, MacGibbon M, Stoklosa J. Human trafficking, mental illness, and addiction: avoiding diagnostic overshadowing. AMA J Ethics. 2017;19(1):23-34.
9. Miller CL, Chisolm-Straker M, Duke G, et al. A framework for the development of healthcare provider education programs on human trafficking part three: recommendations. J Human Trafficking. 2020;6(4):425-434. 
10. Restore NYC. Healthcare access for foreign-national survivors of trafficking. Accessed Dec. 24, 2020.
11. English A. Mandatory reporting of human trafficking: potential benefits and risks of harm. AMA J Ethics. 2017;19(1):54-62. 
12. HEAL Trafficking and Hope for Justice’s protocol toolkit. HEAL Trafficking website. Accessed Dec. 24, 2020.
13. Becker HJ, Bechtel K. Recognizing victims of human trafficking in the pediatric emergency department. Pediatr Emerg Care. 2015;31(2):144-147; quiz 148-150.