By Jeanie Davis, Author

If a sex trafficking victim presented to your ED, would your staff recognize the signs? This victim might seem very much like an “ordinary” person. Most likely she (or he) has a sexually transmitted infection requiring medical attention.

The scenario is complicated by one critical fact: This victim is a source of income. The person who accompanies this victim will “do anything” to protect his or her victim.

Could your hospital’s team handle the situation? Are they prepared to help that victim take first steps in exiting this nightmare?

Rosario V. Sanchez is a forensic nurse and PhD candidate at Rutgers School of Nursing who studies the trauma of sex trafficking. She is working to educate nurses and other hospital staff — including CEOs — on the traumas that these victims experience.

Sanchez wants to help hospital staff recognize trafficking victims and establish hospital protocols that protect and aid a victim’s escape from the trafficking coercion. Safety of both the hospital staff and the victim is a critical concern that must be addressed, Sanchez says.

Human trafficking involves both forced labor and sex trade, with an estimated 40.3 million victims around the world. Seventy-five percent are said to be women and girls. (More information is available online at: https://bit.ly/2kgJE72.)

The population at highest risk is teens, and especially runaways and kids labeled as “troublemakers” who have been in juvenile court. While females are at greatest risk, so are young males — and they often are overlooked, says Sanchez.

Kids from suburban middle-income families also are at risk. “Both parents work, so kids are home alone,” says Sanchez. “The kids are into social media, and that’s where a trafficker can tap into them. These are good kids being lured.”

Traffickers know psychology; they lure young college kids who don’t quite fit in. They may promise great jobs with escort services and modeling agencies, with lots of flattery: “You look so beautiful, you could be a model.”

Protect your own kids by talking to them about these risks, she says, “We think when they hit 18, they know everything. They don’t. We teach them independence — a great thing. But we don’t teach the safety factor.”

Even more disturbing — young children are at risk via adoptions by traffickers, Sanchez adds.

How did our society get to this point? “We were blinded to it for a long time,” she says. “Our eyes weren’t open to the atrocities of this crime. Now that eyes are opening, we must decide, what are we doing as a society?”

Incidence is escalating because it’s a “hidden, profitable crime,” Sanchez says. “They can sell a drug once but can sell a body over and over for years. When they’re done, they sell it to somebody else who will make a profit.”

Most concerning is the complex trauma the victims endure, she says. One survivor she met was 30 years old and had been trafficked since age 8. She had gastrointestinal and heart problems, including a heart attack, all linked to the extensive trauma.

Victims typically enter the healthcare system via the ED. However, OB/GYN facilities and dental clinics also see victims, Sanchez explains. “They’re coming with STIs, often multiple times, due to complications of the infections. Yet no one is asking why they’re coming in that often.”

Nurses have the best chance in rescuing these victims, says Sanchez. But nurses need training to handle the situation optimally and safely.

Congress recently passed a bill mandating that all hospital staff receive training in sex trafficking. The SOAR program has been established to provide training and technical assistance via the National Human Trafficking Training and Technical Assistance Center. This training is specifically for healthcare providers. (The NHTTAC is available online at: https://bit.ly/2iYD8Ad.)

Sanchez foresees one problem with the new federal mandate. “Michigan and Florida have mandated nurses training in human trafficking. But they haven’t specified the type of training. Some hospitals only require reading one article — but how much can they learn?”

Hospitals should set up education programs, Sanchez advises. “If nurses are to respond effectively, the training needs to be standardized.”

She is advocating for a form of trauma-informed care training. “These patients are victims of violence. But the trauma they have been exposed to is not equal to other types of trauma. Nurses must learn the special trauma associated with sex trafficking. They must also acknowledge that each patient is different.”

Sex trafficking is not found in big cities only; it’s everywhere, Sanchez adds. “Sex trafficking has no boundaries, and every nurse should know how to help these victims. It’s a form of modern-day slavery, so damaging to any person who endures it. We are nurses. We must do what we can to help them.”

The trafficker often is within the girl’s immediate family, including her boyfriend or husband. Even if the trafficker was initially a stranger, he knows how to manipulate a young girl or boy, she explains. “He knows how to make them fall in love with him.”

Social isolation, intermittent love and abuse, power control, and the victim’s perceived inability to escape feed the coercion. The victim believes the trafficker will take care of him or her. No matter what happens, the victim will never give up that connection, says Sanchez.

Victims often view healthcare providers and law enforcement as “enemies,” she adds. “It’s frustrating for those who want to help. The victims don’t want your help. Even if you get them into a shelter, they will return to the trafficker.”

But it is important for nurses to make the effort to try to help, as some victims have successfully exited the relationship, she adds. “They have survived the trauma.”

Sanchez believes the long-term trauma changes the young person’s brain when it begins in adolescence, when the brain is still forming. The amygdala becomes triggered so often that there may be a pattern of addiction that forms.

Her research is now focused on adolescents who have exited the coercion. She wants their insights in order to help others. “We’re just coming to understand the complex trauma of human trafficking,” says Sanchez. “But the thing we know is we can reverse it with proper treatment.”