• 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.
• Nationally, 93% of HT victims are Canadian born, often moved from province to province. 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 health care (eg. Hospital/ ED, Women’s Health Clinic, Urgent care clinic, Neighbourhood clinic, etc.)
• HT victims are difficult to identify, resulting in many victims being discharged from the ED back into the hands of their trafficker.
• Identification of HT victims in the ED is crucial. It is the first step toward exiting exploitation and beginning rehabilitation.

Consider risk factors for HT:

• Poverty
• Homeless or runaways
• Female, child/ youth or LGBTQ status
• Lack of formal education
• Ethnic minority groups, including Aboriginal descent
• Youth in foster care/ group home
• History of physical, sexual or emotional abuse
• Mental illness (eg. depression, anxiety, PTSD, psychosis, etc.)
• Substance misuse
• Temporary foreign worker or non-english speaking
• History of involvement with law enforcement

Consider potential indicators of HT:

• Reproductive health issues (eg. STI’s, unwanted pregnancy, abortions, etc)
• Evidence of physical abuse and deprivation
• Workplace injury
• Inappropriate attire
• Tattoos or other forms of branding
• Lack of official documents (eg. MSP, WBC, Passport, etc)
• Constant use of cell phones/ being monitored
• Vague, scripted or inconsistent history
• Unusual behaviour (eg. evasive, anxious, fearful, etc.)
• Presence of a controlling person (eg. Partner, employer, family member, etc.)

If a patient is showing risk factors for HT, screen for violence by separating the patient from their accompaniment and engaging an interpreter (if applicable.)

Consider the following screening questions:

• Tell me about your living situation
• Has anyone ever threatened to harm you or your loved-ones?
• Are you free to come and go as you please?
• Were you (or anyone you work with) ever hurt or threatened for working slowly or for trying to leave?
• Has anyone ever asked you to have sex in exchange for money, food, shelter, or other items?

Some studies have developed screening tools to help identify HT victims, however, validated screening tools that can be largely generalized have yet to be developed.

1. Becker, Heather J. MD, Bechtel, Kirsten MD. Recognizing Victims of Human Trafficking in the Pediatric Emergency Department. Pediatric Emergency Care. February 2015 – Volume 31 – Issue 2 – p 144–147.

   
   

2. Mumma, et al. Screening for Victims of Sex Trafficking in the Emergency Department: A Pilot Program. The Western. Journal Of Emergency Medicine, (2017), 18(4), 616-620 620.

   
   

3. Hachey et al. Identification and Management of Human Trafficking Victims in the Emergency Department. Advanced Emergency Nursing Journal, (2017), Vol. 39, No. 1, pp. 31–51

   
   

4. Greenbaum et al. A Short Screening Tool to Identify Victims of Child Sex Trafficking in the Health Care Setting. Pediatric Emergency Care, (2018), Volume 34, Number 1, pp. 33-37

   
   

5. Lederer et al. The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. Annals of Health Law, (2014), Vol 23, pp. 61-91

   
   

6. Online Module: Human trafficking – Help Don’t Hinder (Fraser Health Authority)