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August 29, 2019
Focus | Human Trafficking in Minors
Did you know?

  • Up to 87% of trafficking victims encounter a healthcare provider during their enslavement and are not recognized, especially by EDs and EMS
  • In one study, 78.8% of trafficking survivors reported accessing healthcare services during their trafficking situation. 68.3% were seen at an emergency department (Lederer & Wetzel, 2014).
  • The trafficking industry generates more income than Nike, Google & Starbucks combined.
  • After drug dealing, human trafficking is tied for second with the illegal arms trade for the most profitable illicit trade in the world.
  • In 2017, the NHTRC hotline documented >10,000 victims of human trafficking in the U.S.
  • 60% of these survivors were minors at the time of being trafficked, but only 1/3 who called the line were minors
  • The average age of entry into child prostitution in the U.S. is 12 years.
  • 70-90% have a history of prior sexual abuse.
  • The National Center for Exploited Children estimates that 100,000 children are exploited each year.
  • 83% of these children are born in the U.S.
  • Florida ranks 3rd in the nation in number of calls to the National Human Trafficking Hotline.
Emergency healthcare providers often miss the signs of human trafficking; mistake them as signs of prostitution, substance abuse/overdose or mental illness; or are unaware of how to help.

Think about human trafficking in every adolescent overdose or STD case.
Definitions:

Trafficking is the recruitment, transportation, transfer, harboring or receipt of persons, adults and children, for use as commodities in conditions of sexual and labor servitude. Tactics used are threat or use of force or other forms of coercion, abduction, fraud, deception, or abuse of power. People are trafficked for prostitution and other forms of sexual exploitation, forced labor or services, slavery or servitude 

Sex trafficking is a commercial sex act is induced by force, fraud or coercion, or in which the person induced to perform such act has not attained 18 years of age. A person under age 18 involved in commercial sex work is a victim of human trafficking regardless of the presence of force, fraud, or coercion .
Pediatric Trafficking

  • As many as 300,000 school-age children are at risk for sexual exploitation each year in the United States.
  • One in four girls and one in six boys will be sexually assaulted by age of 18.
  • The life expectancy of the commercially exploited “prostitute” is seven years.
  • Approximately one in seven youth online (10 to 17 years-old) received a sexual solicitation or approach over the Internet.

Runaways

  • 1 in 5 teenagers run away from home
  • 30,000–40,000 pre-teen/teen runaways in Florida at any given time
  • 1 in 3 teenagers are lured into prostitution within 48 hours of leaving home
  • Within 3 months of being away from home, 90% of US children will turn to sex for survival
Warning Signs & Barriers :

Signs that a Minor May be a Human Trafficking Victim

  • Misses school on a regular basis and/or has unexplained absences
  • Frequently runs away from home
  • Makes references to frequent travel to other cities or towns
  • Signs of physical trauma, withdrawn behavior, depression, anxiety or fear
  • Lacks control over her or his schedule and/or identification or travel documents
  • Hungry, malnourished or inappropriately dressed (based on weather conditions or surroundings)
  • Shows signs of drug addiction/substance abuse
  • Has coached/rehearsed responses to questions
  • Demonstrates a sudden change in attire, behavior, relationships or material possessions (e.g., has expensive items), grooming
  • Is uncharacteristically promiscuous, makes references to sexual situations or terminology that are beyond age-specific norms
  • Has a “boyfriend” or a “girlfriend” who is noticeably older
  • Attempts to conceal recent scars
  • Shows a sudden change in attention to personal hygiene
  • Teens who are already involved with traffickers are used to recruit other victims

Red Flags for EMS

  • Rooms with numerous beds on the floor
  • Small rooms that have locks on outside of doors
  • Locks on windows

Barriers to Identifying HT Victims

  • Lack of awareness or time constraints in busy ED or field
  • Use companion for translation in a non-English speaking patient—always use an official medically trained interpreter or language line if possible
  • Fear initiating deportation of illegal person
  • Do not look at full picture; focus on medical complaint only
  • Do not know interview techniques to use on a withdrawn patient
  • Do not identify relationship of other parties with the minor

What Can You Do?

  • Separate victim from trafficker if possible
  • Document, document—photos if possible
  • Call and report:
  • Local law enforcement
  • Department of Children & Families: 1-800-96-ABUSE
  • National Human Trafficking Resource Center Hotline: 1-888-373-7888
  • Find the name and contact number for your DCF Regional Human Trafficking Coordinator
  • Develop an ED Screening Process
  • Check out resources below
If something doesn’t seem right, act on that instinct. Question the story!
Resources:

Continuing Education Legislation:

PECC Champions of the Week:
This week we congratulate Sarasota County Fire Department on having two PEDReady Champions!

The first is Captain Jeremiah Rabish , pediatric emergency care coordinator and champion for Sarasota County Fire Department. Captain Rabish has been a role model for an outstanding PECC and champion. He was nominated for improving care in his agency in many ways, including updating pediatric airway equipment from uncuffed to cuffed ET tubes, researching safe transport of children, acquiring pediatric safe transport devices, revising pediatric protocols, becoming a Handtevy pediatric program instructor and more.

Thank you, Captain Rabish!

Our second PEDReady Champion is Dr. Marshall Frank, DO, MPH, FACEP . Dr. Frank is Medical Director of Sarasota County Fire Department and Suncoast Technical College and a Clinical Assistant Professor at FSU College of Medicine. Dr. Frank attended the inaugural PECC workshop at this year’s NAEMSP meeting, was one of the first medical directors to embrace the concept of PECCs, attends EMSC Advisory Committee meetings and nominated Captain Rabish. Go team Sarasota!
Become a PECC in your agency or ED!
Upcoming Pediatric Emergency Events
Children's Disaster Services Workshop
October 11-12, 2019 | Tampa, FL
Hosted by: Child Life Disaster Relief

This is a specialized training for Certified Child Life Professionals only. Certified child life specialists are invited to register. Ten PDU’s are available.
Pediatric Care After Resuscitation (PCAR) Course
Dec 2-3, 2019 | Jacksonville, FL

The mission of TCAR (Trauma Care After Resuscitation) Education Programs is to expand the knowledge base and clinical reasoning skills of nurses who work with injured patients anywhere along the trauma continuum of care, particularly in the post-resuscitation phase. 
Thanks for being a Pediatric Champion!
The Florida PEDReady Program
pedready@jax.ufl.edu | 904-244-8617