Caring for Human Trafficking and Exploitation Victims in the Emergency Department
- Human Trafficking (HT) and exploitation is a clandestine crime that victimizes vulnerable Canadians, including women, children/ youth and members of the LGBTQ community. Forms of HT encountered in the Emergency Department (ED) may include sex trafficking, forced labor, forced criminal activity, and illegal organ donation. (See Identifying Victims in the Emergency Department for an introduction to HT and exploitation.)
- During the trafficking process, up to 63% of victims seek medical care in the ED, while nearly 88% of victims have contact with some form of healthcare (eg. Hospital/ ED, Women’s Health Clinic, Urgent care clinic, Neighbourhood clinic, etc.)
- Though emergency physicians are considered the primary health care providers of HT victims, more than 95% of ED physicians are not trained in identifying and caring for victims. I have provided guidelines below to assist physicians in this situation.
Prepare your environment:
- Safety first! Activate security if there is an active threat to your patient or to hospital personnel. Mark your patient with a “Do Not Announce” alert on your medical record system, to prevent identification by outsiders.
- Interview and examine your patient in a private space, where they may feel more comfortable disclosing violence. Avoid placing these patients in the ED hallway or waiting room.
Prepare your patient:
- Treat their medical injuries and illnesses before consideration of social and forensic care.
- Screen and treat STI’s, exposures, and pregnancy. If possible, defer the genitourinary exam to your forensic team.
- Address their basic needs: many patients have not had access to food, sleep, or security.
- Document carefully, with a medico-legal perspective in mind. It is recommended to directly quote patients and include hand drawn diagrams on your chart.
Use a trauma-informed approach:
- Express empathy and show respect.
- Avoid re-traumatization through multiple questioning.
- Offer same-sex clinician.
- Favour open ended questions.
- Review their right to confidentiality (ie. They do not have to involve authorities to receive medical care or social assistance.)
- Expect aggression, belligerence, guarding. These are clues indicative of trauma and victimization.
Connect your patient with social work:
- These patients will often require social assistance, safe housing, connection to detox, connection to law enforcement, assistance with immigration issues, etc. Involve your social worker early!
Mobilize hospital resources:
- Addictions Services: starting a patient on Methadone or Suboxone can be a huge step toward recovery!
- Interpreter Services
- Aboriginal Health
- Forensic or Sexual Assault Service: Patients may undergo a forensic exam within 7 days of sexual violence. Even if they do not meet inclusion criteria for a forensic exam, it is prudent to contact your hospital’s forensic service for advice.
- Learn what other resources are available through your hospital.
Mobilize community resources:
- Deborah’s Gate: Anti-Human Trafficking Program (604-915-5678 / 1-855-332-4283) https://www.deborahsgate.ca
- Residential Program: Place for 10 victims fleeing a real or unknown threat of violence. Victims received customized wrap-around care with 24/7 staff support at no cost to survivor.
- New Hope Outreach Workers: 24 hr service offers assistance for ANY individual who has experienced trafficking and/or exploitation. Their case workers can be the first point of contact for survivors. They offer case coordination & case management of upwards of 250 clients per year. Victims can self-refer.
- Ministry of Child and Family Development (1-800-663-9122): Health providers must report all cases involving minors (patients less than 19 years of age)
- Learn what specific resources are available through in your community. Also, see additional community resources below.
Criteria For Hospital Admission
- Admit patients who require further medical or psychiatric management (eg. sick patients, unstable patients, certified patients, etc.)
- Recommend social admissions for underage victims (less than 19 yo) and for adults who consent to a hospital stay.
- Caring for HT victims is complex and it requires significant resource mobilization.
- These are not cases that can be resolved in a short ED visit.
Criteria For Safe Discharge Home
- It can take two to ten contacts with front-line workers before a victim is ready to accept help. Do not get discouraged. Offer them resources available through your hospital and in your community. Most importantly, invite them back to the ED when they are ready receive help.
Quality Of Evidence?
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Human trafficking is significantly under-reported: up to 90% of victims do not report to authorities. As a result, large studies are limited. Much of the research in this area is observational, retrospective, and qualitative.
OTHER RELEVANT INFORMATION
Local Police Jurisdiction or RCMP: Adult patients must consent to involve authorities before we can call the police. Most jurisdictions will have Victim Services available.
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by the BC Emergency Medicine Network and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. The BC Emergency Medicine Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. The BC Emergency Medicine Network also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Nov 28, 2019
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