C is for a Call to Create: Creating a Departmental Response to Human Trafficking

Care, Consider, Communicate, Connect, Create. This is often my mantra when it comes to thinking about human trafficking. So naturally, this little mantra fits in well with the “C” of the ABCs of EM. Truthfully, this is an approach that we should be utilizing with all our patients.

So in sum, The 5 C’s:

• Continue to CARE for all medical needs first
• Consider risk factors and indicators that may indicate trafficking experiences
• Communicate in a trauma informed approach
• Connect individuals to resources as guided by their interest and needs
• Create health goals to promote health and safety on discharge

While it seems easy enough to say the above mantra, in truth, human trafficking is a very complex issue. It truly can affect anyone, anytime, anywhere. With this Anyone, Anytime, Anywhere, 24-7-365 mentality of Emergency Medicine, it is not surprising that as Emergency Physicians we are acutely attuned to the fact that we are often the safety net of our community. It is incredibly difficult to know the numbers of those affected by human trafficking, but we do know that up to 88% of individuals affected by human trafficking saw someone in health care during their experience.

In such, it is essential to develop human trafficking specific education and protocols within our departments and health care facilities. This is no easy task, and certainly all protocols and resources have limits. Nevertheless, by building protocols we begin to understand the community we work in better. We recognize our resource limitations and hopefully can work towards bridging the gaps identified. Perhaps equally as important, through resource building and community engagement, we have an opportunity to prevent human trafficking even before it starts. The HEAL organization has a fantastic toolkit to help you build a protocol for your department.

Now that I have you ready to answer the call, I must also warn you against the rescue mentality that often follows. In the 5 Cs above, there is no mention of obtaining disclosure of human

trafficking. Nor is it a necessary failure on our part when we suspect someone is affected by trafficking and they choose not to disclose to us or accept our assistance. Instead, as with all our patients in the ED, if we Care for their needs, Consider the social context of their health, Communicate with the knowledge that trauma is common, and Connect them to resources that they desire, we are then able to Create discharge plans together that are well informed by our patient’s autonomy.

And finally, remember that trauma exists outside the trauma and resuscitation bays our departments. And just because the shift has ended, doesn’t mean we are not taking the stories of our patient and our combined experiences home with us. We all know that secondary trauma exists, but far too often we overlook how these cases impact our well-being.  So for the last call to action on the list, please take care of yourself and your colleagues. We are all in this together.

PEARR Model: Privacy – Educate – Ask – Respect – Respond
Learn More (PDF)

HEAL Trafficking Toolkit for Protocol Development
Learn More

Protocol Pearls:
Remember to Include Labor Trafficking
Strive for Survivor Informed and Survivor Led Protocols
Engage with Community Partners and Build Connections with Resources
Know Mandatory Reporting Laws
Consider how to Document Safely

Shannon Findlay, MD, MPH, CTropMed
Clinical Assistant Professor
University of Iowa Hospital and Clinics