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the task force to collaborate with the Department of Family and Protective Services and the Health and Human Services Commission to identify and assist victims of human trafficking). 31. LA. REV. STAT. ANN. § 46:2161 (2014); TENN. CODE ANN. § 71–1-135 (2012); WASH. REV. CODE § 18.71.080 (2009). 32. N.J. STAT. ANN. §§ 2 C:13–12 (2013), 26:2 H-2 (2013). 33. N.J. STAT. ANN. § 26:2 H-2 (defining “health care facility” as a “facility or institution whether public or private, engaged principally in providing services for health maintenance organizations, diagnosis, or treatment of human disease, pain, injury, deformity, or physical condition, including, but not limited to, a general hospital, special hospital, mental hospital, public health center, diagnostic center, treatment center, rehabilitation center, extended care facility, skilled nursing home, nursing home, intermediate care facility, tuberculosis hospital, chronic disease hospital, maternity hospital, outpatient clinic, dispensary, home health care agency, residential health care facility, and bioanalytical laboratory (except as specifically excluded hereunder) or central services facility serving one or more such institutions but excluding institutions that provide healing solely by prayer and excluding such bioanalytical laboratories as are independently owned and operated, and are not owned, operated, managed, or controlled, in whole or in part, directly or indirectly by any one or more health care facilities, and the predominant source of business of which is not by contract with health care facilities within the State of New Jersey and which solicit or accept specimens and operate predominantly in interstate commerce”). 34. FLA. STAT. § 456.031 (2009); Florida Medical Association. Domestic Violence with a Special Focus on Human Trafficking 2015. Available at: https://flmedical.inreachce.com/Details/Information/e77e8031-1e98-4592-80ad04ce88e09820. 19 February 2016. 35. N.J. STAT. ANN § 2C:13–12(b)(1) (2013)Only 10% of physicians recognize the signs of human trafficking. Only 3% of emergency physicians receive training in identifying victims of human trafficking. 83% of victims of human trafficking seek medical treatment.Knowledge is a powerful weapon in fighting this horrifying crime.Human trafficking generates an estimated $33.9 billion worldwide and is the 3rd largest source of income for organized crime. According to the 2017 US Department of State Trafficking in Persons Report, there were 100,409 victims identified across the globe in 2017, which has more than doubled since 2014.3 In the United States there were 8,524 confirmed cases of human trafficking in 2017, and the numbers are climbing every year.Despite these growing numbers, it is estimated that less than 1% of victims have been identified due to difficulty obtaining accurate surveillance data. Human trafficking can be further categorized into sex trafficking and labor trafficking. Sex trafficking is the recruitment, harboring, transportation, provision, or obtaining of a person for a commercial sex act, in which commercial sex is induced by force, fraud, or coercion, or in which the person induced to perform such an act is below 18 years of age. Labor trafficking is any means of obtaining a person for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. The majority of human trafficking victims are women who are subjected to sex trafficking and domestic work. Risk factors for human trafficking include poverty, lack of education, undocumented immigrant status, marginalized populations such as LGBTQ, personal history of abuse, and an unstable family home. The states with the highest reported cases of human trafficking are California, followed by Texas and Florida. According to a study, 87% of sex trafficking survivors received medical care at some point during their trafficking. Of these, the most common healthcare setting was the emergency department. Unfortunately only 10% of physicians recognize human trafficking victims and a mere 3% of emergency physicians receive training on human trafficking. Trafficking can also be confused with overlapping crimes like domestic violence, drug addiction, sexual assault, and prostitution. It is imperative that healthcare professionals receive training on the identification and treatment of victims of human trafficking, along with how to provide a trauma-informed approach to care. BARRIERS TO DISCLOSURE There are numerous barriers that prevent victims from disclosing their situation. Fear of arrest or deportation, fear of retaliation by the trafficker, distrust of authority figures, prior negative experiences with seeking for help, and re-traumatization when asked repeatedly to disclose the details of their abuse are just a few. Many victims are being tracked via GPS on their phone by the trafficker and simply don’t feel safe. Others truly believe that they are willingly complying with the abuse (referred to as trauma bonding) and don’t realize they are being trafficked, that safe alternatives exist, or that they have legal rights. Illegal immigrants in particular are at increased risk due to multiple risk factors. PROVIDING TRAUMA INFORMED CARE Understanding the trauma patients have experienced is fundamental to providing a victim centered approach to care. Providers need to understand that by the time they encounter survivors they have already been threatened with violence from traffickers, buyers, and/or employers. They have suffered the consequences of prior attempts at seeking help. They have been subjugated to repeated victimization on a daily basis and doing nothing may have been self-protective. As one victim shares, “It is important for anyone working with victims of commercial sexual exploitation to realize that this population is very reluctant to reveal anything personal…to adults, especially in professional positions…Many victims have been in circumstances where adults have consistently let them down.” After understanding their trauma experience and barriers to disclosure, providers may provide the emotional safety needed to offer help. The first step of providing trauma informed care is attending to the basic needs of the patient. If they are cold or wet, offer a change of clothes and a warm blanket. If they’re hungry, offer them food. Reassure the potential survivor and build trust and rapport. It is of utmost importance that the provider be conscious of his/her language. For example, asking “what happened to you?” as opposed to “what’s wrong with you?” Do not act shocked or disgusted when the patient discloses information. These patients are the most sensitive to power dynamics. Sit at their level and do not force disclosure of their situation. Victims are known to “test” the healthcare setting by making several visits before deciding if it would be safe to ask for help. In addition, be sensitive if patients do not want to file a police report as many have a warrant out for their arrest. Above all, avoid re-traumatization caused by recounting their abuse experiences. GENERAL INDICATORS OF HUMAN TRAFFICKING If you’re not looking for human trafficking, you’re going to miss it! Patients will often provide a scripted or inconsistent history. It is not uncommon for the paramedics to provide a concerning history and the patient deny it altogether. This behavior grants the patient control over the process. Patients are often fearful, avoid eye contact, or may come off as hostile. It is safer to get angry at the advocate than the abuser. They may not know their home address, nor the current date or time. Victims often do not have possession of their personal identification and are not in control of their own money. INDICATORS OF SEX TRAFFICKING Victims of sex trafficking frequent the emergency department. They come in Baker Acted for overdose attempt, have a history of multiple STIs, or come in with vague abdominal pain and depression. They may be accompanied by an older, controlling individual who speaks for them, claiming to be their “boyfriend,” “cousin,” etc. They may have tattoos or branding that say “Daddy,” “Property of…,” etc. History of multiple abortions is not uncommon. Patients often have somatization symptoms such as recurring headaches or pelvic pain. Pay attention to signs of trauma that are inconsistent with the patient’s explanation. Unfortunately most victims of sex trafficking at some point suffer from drug abuse, depression, and suicidal ideations, which often cloud the clinical picture. Traffickers are known to recruit in drug addiction clinics.