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have not yet tackled any human trafficking cases, but we hope to be available when they arise to help the victims find security and rebuild their lives. The crime of human trafficking thrives in an atmosphere of indifference. Together, we can tackle this scourge head on and provide much needed care to the most exploited and marginalized members of our state and our society.Human Trafficking Overview for Emergency Medicine Personnel Introduction Florida Attorney General Pam Bondi is dedicated to making Florida a zero-tolerance state for human trafficking, and she believes that emergency medicine personnel can assist in this effort. By learning about common signs and ways of responding to potential human trafficking situations, emergency medicine personnel can help end this horrific crime and help protect victims. Important Facts to be Aware of • Human trafficking is a form of modern-day slavery. • Victims may be exploited for forced commercial sex or forced labor. • Traffickers use physical force, fraud, or psychological coercion to achieve exploitation. • Victims include foreign nationals, U.S. citizen adults, and increasingly, U.S. citizen minors. • According to the Family Violence Prevention Fund, “28% of trafficking survivors in one study said they came into contact with a healthcare provider during the trafficking situation, and were not recognized.” • The National Human Trafficking Resource Center hotline should be posted in all highly visible areas of the ER. • Internal and external reporting protocols should be established. • The Polaris Project offers a “Recognizing and Responding to Human Trafficking in a Healthcare Context” training video, which includes helpful information and case studies. The video can be accessed here: https://polarisproject.adobeconnect.com/_a983384736/medical-module/ General Indicators of Trafficking • Victim typically lacks identification documents – may claim to be “just visiting.” • Victim may have no fixed address or may be unable to identify where he or she is living. • Victim may be under the control of another—possibly the person accompanying him or her. • Victim may exhibit fear, hyper-vigilance, depression, submissiveness, or acute anxiety (PTSD). • Victim will typically not be in control of their own money or identification documents. • Victim may be unable or reluctant to explain the nature of an injury. • Third party may attempt to speak on behalf of the victim. Common Health Care Indicators of Trafficking • Headaches (among the most prevalent and enduring physical symptoms of trafficking). • Malnourishment, anemia, or other signs of medical neglect. • Signs of physical abuse, such as: bruises, burns, cigarette burns, cuts, broken or missing teeth, dislocated limbs or fractures, or tattoo branding of a pimp’s name. • Evidence of prolonged infections or medical conditions that have gone untreated. • Skin rashes or exposure to infectious diseases such as tuberculosis. • Potential substance abuse issues incurred as escape mechanisms from exploitation. Potential Indicators of Sex Trafficking • Sexually transmitted diseases, pelvic pain, jaw and neck problems, unusually high number of sex partners, rectal trauma, miscarriages caused by potential abuse, or urinary infections arising from recurring engagement in the commercial sex industry. • Medical complications from untreated STDs or botched or unsafe abortions. • Evidence of beatings or burnings of victims in areas of the body that will not damage a victim’s outward appearance (i.e., the lower back). • Genital evidence that victim has had to engage in sexual intercourse while on her monthly cycle (i.e., use of cotton balls or other products that leave residual fibers). Potential Indicators of Labor Trafficking • Injuries from exposure to occupational hazards (asbestos, pesticides, kitchen burns, chemical exposure, etc.). • Chronic back, hearing, cardiovascular, or respiratory problems incurred from excessive labor. • Accidental worksite injuries, such as: dehydration, heat stress/stroke, musculoskeletal and ergonomic injuries, water and sanitation related illnesses, sleep deprivation. Example Rapid Assessment Questions • Who is the person who came with you? Tell me about him or her. • Did you ever feel pressured to do something you didn’t want to