Human trafficking

Last updated: July 13, 2023

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Summarytoggle arrow icon

Human trafficking is the recruitment, harboring, transportation, or provision of a person for the purpose of labor and/or sexual exploitation through the use of force, fraud, or coercion. Signs of human trafficking are often nonspecific and a high index of suspicion is required to identify affected individuals. Patients may appear fearful and present with injuries inconsistent with their medical history and signs of neglect, abuse, or malnutrition. Management includes treating acute injuries and medical conditions, provision of appropriate local human trafficking resources, and following local laws and institutional guidelines on reporting suspected cases.

Definitiontoggle arrow icon

The recruitment, harboring, transportation, or provision of a person for the purpose of labor and/or sexual exploitation through the use of force, fraud, or coercion [2][3]

Epidemiologytoggle arrow icon

  • Anyone can be a victim of human trafficking, regardless of age, gender, sexual orientation, or socioeconomic status. [3]
  • Individuals who have experienced or been exposed to violence or who are disconnected from stable support networks are disproportionately targeted by traffickers.
  • Approximately 60% of victims of human trafficking will visit an emergency department at some point during their exploitation. [3][4]

Epidemiological data refers to the US, unless otherwise specified.

Red flagstoggle arrow icon

Suspect human trafficking if any of the following are present: [3][4]

  • History
    • Medical history inconsistent with the injury
    • Delay between onset of illness or injury and seeking medical care
    • Frequent relocation
  • Examination findings
    • Signs of neglect and/or malnutrition
    • Branding, e.g., a tattoo or intentional scarring
  • Behavioral
    • Flat, fearful, and/or submissive affect
    • Difficulty answering simple personal questions
    • Answers controlled by an accompanying individual
  • Other
    • Inappropriate clothing for the weather or reported activity at the time of injury
    • Patient appearing younger than their stated age
    • Missing or fraudulent personal identification documents

Diagnosticstoggle arrow icon

Clinical evaluation [4]

Rapid Appraisal for Trafficking (RAFT) [2]

A four-question screening tool; an affirmative answer to any of the following questions warrants further investigation:

  1. Have you ever worked or done things in a place that made you feel scared or unsafe?
  2. Have you ever been tricked or forced into doing work you did not want to do?
  3. Have you ever been afraid to leave or quit a work situation due to fears of violence or threats of harm to yourself or your family?
  4. Have you ever received anything in exchange for sex (e.g., a place to stay, gifts, food)?


Managementtoggle arrow icon

General principles [3][4]

  • Obtain informed consent for every diagnostic and management step.
  • Attempt to speak to the patient in private with a chaperone.
  • Maintain a low threshold for notifying hospital security about suspected human trafficking to ensure the safety of the patient and staff.
  • Contact the National Human Trafficking Hotline for advice on the appropriate next steps. [3]
  • Involve a multidisciplinary team early.
  • Follow local protocols for preparing accurate medical documentation for potential criminal proceedings.

Treatment [3][4]

  • Evaluate and treat acute injuries (e.g., fractures) and medical conditions.
  • Offer treatment for other injuries and any undertreated medical conditions, e.g., STIs.

Reporting [3][4][5]

  • Follow local laws and institutional guidelines on reporting suspected child abuse, older adult abuse, abuse of at-risk adults, and abuse involving a firearm. [4]
  • Allow all other adults to choose whether and how to report abuse or seek help. [3][5]

Disposition [3][4]

  • Admit patients if there are any clinical indications.
  • Involve social workers, case managers, and/or advocates if the patient is returning to an exploitative situation.
  • Provide patients with contact information for the National Human Trafficking Resource Center and local resources. [3]

In the United States, the National Human Trafficking Hotline can be accessed by calling 1-888-373-7888 or texting “INFO” or “HELP” to BEFREE (233733). [4][6]

Referencestoggle arrow icon

  1. Chisolm‐Straker M, Singer E, Strong D, et al. Validation of a screening tool for labor and sex trafficking among emergency department patients. J Am Coll of Emerg Physicians Open. 2021; 2 (5).doi: 10.1002/emp2.12558 . | Open in Read by QxMD
  2. Shandro J, Chisolm-Straker M, Duber HC, et al. Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. Ann Emerg Med. 2016; 68 (4): p.501-508.e1.doi: 10.1016/j.annemergmed.2016.03.049 . | Open in Read by QxMD
  3. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  4. $Contributor Disclosures - Human trafficking. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy.
  5. ACEP policy statement on human trafficking. Updated: February 1, 2020. Accessed: December 19, 2022.
  6. Blue Campaign: One Voice. One Mission. End Human Trafficking.,INFO%20to%20BeFree%20(233733). . Accessed: December 19, 2022.

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