In hindsight, LoCascio suspects the girl may have been a victim of human trafficking. At the time, it seemed hard to imagine this type of abuse was a problem in the U.S. But a second similar incident motivated LoCascio to start asking nurse and law enforcement experts about the issue.
Although it may seem difficult to help victims who often are hidden from the public eye, these people may surface when they seek medical treatment. "The most important thing is be aware that human trafficking exists," said Lisa Creamer, RN, BSN, assistant director of Child Abuse Pediatrics at Texas Childrenís Hospital in Houston, Texas. "If you donít recognize that it exists, you wonít recognize it when you see the signs. As nurses, we can ask questions and watch for behaviors that give us clues that someone is being forced to do something they donít want to do."
Though a victim of human trafficking may come to the ED for a variety of reasons, some of the most common are for treatment of sexually transmitted diseases or infectious diseases, said Patricia Crane, RN, MSN, PhD, WHNP-BC, an assistant professor at the University of Texas Medical Branch School of Nursing in Galveston. Crane educates healthcare providers nationally and internationally about how to identify and help victims of human trafficking. Infectious diseases are common because many of the victims are trapped in unsanitary, crowded living conditions, she said.
"Some of the signs to watch for are people who cannot answer the questions you ask, have no driverís license or wallet and cannot be separated from the person with them," Crane said. "Itís also a red flag if you keep asking the patient questions but the person with them answers."
When nurses suspect they might be treating a victim of human trafficking, one of the first barriers to overcome is separating the patient from the trafficker in the room, said Rita Hall, RN, MSN, SANE-A, SANE-P, ARNP, a clinical supervisor at the Crisis Center of Tampa Bay. "I might walk her to the bathroom alone, and that could give me a few seconds to ask her if she feels safe with the person who brought her or if anyone is forcing her to do things she doesnít want to do," Hall said.
It also is important for nurses to notify the physician and social worker, LoCascio said. "Notify the provider about your suspicions because the doctor may have advanced skills to ascertain more information, and sometimes your suspicion alone might trigger another caregiver to go through a chart and find other clues."
While some victims may want help from medical caregivers, there also are many cases in which the victims do not want to change their situation, said Crane. She remembers a young woman in Texas who suffered from vaginal bleeding and infection because of long hours of sex work every day. She received free surgery for vaginal and anal tissue damage, and the staff at the hospital offered to help her escape her situation, but she would not reveal who the trafficker was. Within three weeks she returned to the trafficker, Crane said.
"For nurses, it is important to understand that it is not about us controlling the situation, but about helping people see that there is a way to get out when they are ready," Crane said. "These people are captives and feel controlled, so it is a slow process of building trust, and it may not happen in one visit. Let them know that they can come back."
Heather Stringer is a freelance writer. Post a comment below or email editorSouth@nurse.com.