Nurse Rosario Sanchez has worked with trafficking victims who have escaped their captors. From their insights, she has developed specific steps to help nurses who encounter a potential victim.

First, the nurse’s focus should be on providing necessary medical care. In the intake phase, it is not necessary to get details of the whole history of trauma. Focus on diagnosing and treating the current medical condition.

Say, “Hi, how are you feeling? Would you like a cup of tea, or glass of water?” “When somebody treats [the victim] like a human being, they begin to trust,” says Sanchez.

She describes a safe way to separate the perpetrator from his victim. Tell him the front desk needs insurance forms to be completed. Then, take the victim into an examining room. It is a simple transition that works very smoothly, she says.

It is important to spot the following red flags:

  • burns, bruises, broken teeth, and signs of physical trauma;
  • current/frequent STIs (gonorrhea, chlamydia, HIV);
  • weight loss, malnutrition;
  • broken teeth/bones;
  • substance abuse;
  • tattoos such as a bar code or “Daddy”;
  • confusing/contradictory details;
  • inability to focus or concentrate;
  • does not know his or her location/age/time.

If the victim presents with a sexually transmitted infection, a way to secure a safe place is to arrange an observational one-day admit to the hospital. That should be standard protocol, especially if the victim wants to escape, says Sanchez. This transition must be handled with utmost care to ensure safety for both hospital staff and the victim/patient. Hospital security should get involved.

To ensure patient and staff safety, each organization should develop a protocol for human trafficking that includes these elements: staff training; multidisciplinary approach; screening and identification; mandatory reporting; follow-through procedures.

“It’s the same as domestic violence — once the perpetrator loses control, that’s when victim is in the most danger,” Sanchez says. “If the perpetrator fears they will go to jail or lose income, they are going to kill the victim.”

By admitting the patient, you provide that safety. “This allows the victim a safe environment where the trafficker doesn’t have access. This is the best way to gain her trust and rescue her.”

After the patient has been admitted, the next step: “If the girl looks malnourished, you must provide food. Offer a warm meal. Does she need shelter?” Sanchez asks. “Focus on building trust slowly. Don’t ask too many questions too quickly. They must feel rapport with you so they can tell you everything.”

If the victim refuses to exit the trafficking relationship, says Sanchez, then provide the victim with community resources, along with the National Human Trafficking Hotline. Do not discharge a victim without any resources.

Sanchez reports that in the state of New Jersey, alerting the police department will be the first step. Then, the case will be referred to a detective and the county prosecutor’s human trafficking liaison, who then will investigate the circumstances that prompted the investigation and the results of the investigation to date.

She advises that a forensic nurse needs to be part of the ED staff in every best practice organization. “The forensic nurse has been trained to deal with this sort of situation, he or she knows how to handle the perpetrator and maintain a safe environment not only for the victims but also for staff members, and is able to provide a medium of communication between law enforcement and the medical staff,” Sanchez says.

If a forensic nurse is not available, the ED staff should receive comprehensive training on the organization’s human trafficking protocol, Sanchez says. “It is critical to remain calm, provide support to victims, and remain focused on the task at hand — the medical event that brought them to the ER.”