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Clinical scenario: Human Trafficking

A 14-year-old male presents to the emergency department. The patient is dehydrated, malnourished, and weak, but has no explanation as to how he got into this condition. Additionally, the patient exhibits multiple bruises in various stages of healing on his torso and arms. He seems nervous and avoids eye contact. He also lacks identification documents and is unsure of his home address.  He is accompanied by a man who claims to be his uncle. The ER team suspects forced-labor human trafficking.

Vital signs:

·      Heart rate: 110 bpm

·      Blood pressure: 90/60 mmHg

·      Respiratory rate: 18 breaths/minute

·      Temperature: 37.5°C (99.5°F)

·      Oxygen saturation: 97% on room air

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S: A 14-year-old male is admitted to the emergency department with signs of dehydration, malnourishment, and weakness. Along with those symptoms, patient also have bruises of various stages of healing on his torso and arms. Patient has no forms of identification.

B: Patient cannot verbalize how he became dehydrated, malnourished, or weak. Patient has a visitor who he claims is his uncle at the bedside. He seems nervous and avoids eye contact.

A: Health care workers suspect the patient may be a victim of forced human trafficking. His vital signs are 110 bpm for heart rate, 90/60 blood pressure, 18 breaths per minute for respirations, 99.5F for temperature, and 97 percent oxygen saturation on room air.

R: I recommend getting the patient alone from his “uncle” and asking the patient if he is a victim of human trafficking and following appropriate hospital protocol accordingly. Remind patient he is safe. Vital signs should be monitoring every hour and be monitored for any deterioration. Recommend that the provider order IV fluids and encourage patient drink fluids to address dehydration.

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1.     Psychological Trauma & Fear – Victims can often suffer from psychological problems, such as anxiety, PTSD, depression, and fear of their traffickers. All of these can make communication difficult and hinder the victim to accept help.

2.     Fear & Distrust of Authorities – Victims may refuse help due to repeated threats from traffickers, have fear of law enforcement, or previous negative experiences with authorities.

3.     Risk of Retaliation from Traffickers – If traffickers suspect a victim is seeking help, they may threaten or harm the patient, their family, or even hospital staff. This keeps victims suppressed and not tell a healthcare member that they need help even when they are in a hospital.

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Psychological Trauma and Fear

1) Assess for physical injuries, infections, malnutrition, substance abuse, provide pyschological and mental evaluation/care, and other untreated medical conditions that the patient may have.

2) Screen patients for mental health concerns, such as PTSD, anxiety, depression, drug abuse, alcohol addiction, and suicidal ideation.

3) Use non-judgmental and open-ended questions to assess the patient’s situation while avoiding re-traumatization. Active listening is cruical for victims of abuse.

Fear & Distrust of Authorities

1) Provide a private, safe, nonjudgemental environment away from potential traffickers and triggers that may remind the patient of the event.

2) Use trauma care with patients: speak calmly, avoid judgment, use active listening, and empower the patient to tell their story. This is the time to use active listening with patients.

3) Assess for immediate safety risks (e.g., threats from traffickers, self-harm risk) and collaborate with hospital security or social services if needed.

Risk of Retaliation from Traffickers

1) Involve social workers, case managers, foster care, and law enforcement if needed while ensuring confidentiality and a safe environment with your patient.

2) Offer self to the patient to ensure they feel comfortable with sharing intimate details and will stay with them for as long as they need.

3) Provide information on shelters, legal aid, and crisis hotlines such as the National Human Trafficking Hotline (1-888-373-7888 in the U.S.) or the domestic violence hotline (800-799-7233 in the U.S.).

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1. Risk for trauma and physical violence related to multiple bruises in various stages of healing on torso and arms (highest priority)

This is the nurses highest priority because the patient may have internal injuries that the nurse may not see or may have life-threatening injuries related to their abuse.

2. Fear related to perceived danger and threat as evidence by avoidant eye contact with nervousness

3. Imbalanced nutrition related to malnourishment as evidence by 90/60 mmHg and dehydration status

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Psychological Trauma and Fear - what can the provider do/order the nurse to do?

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Psychological Trauma and Fear - what can the provider do/order the nurse to do?

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A provider may order the nurse do access patient safety.

Rationale: The patient appears withdrawn and unable to identify patient identification. He appears uncomfortable and is unable to open up with his “uncle” in the room.

1) Ensure Patient Safety & Confidentiality.

Conduct the exam privately without anyone other than the nurse and patient. If a trafficker refuses to leave the patient during this time, come up with ways to get the patient by themselves. Ex: "How about grabbing a cup of coffee in the lobby?"

Avoid direct confrontation—victims may be fearful, distrustful, or under threat. Victims may have been brainwashed by their traffickers into not wanting help.

If immediate danger is suspected, involve hospital security and follow hospital protocols.

2. Perform a Comprehensive Medical & Psychological Evaluation

Assess for physical injuries (fractures, burns, bruises), malnutrition, dehydration, infections, and STIs. Provide fluids and electrolytes.

Screen for mental health concerns (PTSD, depression, anxiety, substance abuse/withdrawal, and suicidal thoughts).

Identify physical signs of substance abuse (tremor, irritability, constricted/dilated pupils, etc.) as traffickers often use drugs to control victims.

3. Use Trauma-Informed Communication

Use open ended questions to gain more information about the patient.

Ask open-ended, non-judgmental questions like:

"Can you tell me about your home environment?"

"Do you feel safe where you stay?"

"Has anyone threatened you or your family?"

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Human trafficking is the act of exploitation of human beings for forced labor and sexual submission for profit or gain.