Methods: For this study, emergency centers in five South Texas trauma service areas were selected as the setting for this descriptive research study. The 47 counties in these 5 South Texas trauma service areas include a mixture of urban, suburban, and rural areas. A substantial number of the counties are considered border counties as they are located within 100km of the Rio Grande River on the U.S. border of Mexico.11 The population within the 47 counties is predominately white and predominately Hispanic, with the majority of the counties more than 50% Hispanic.11 The counties have a high percentage of individuals who are poor, with a majority of the population reporting greater than 20% poverty.11 The population of the counties is young with a median age below the Texas median age of 33.6 years, in one of the five youngest states in the United States.11 Within these 47 counties, there are 99 emergency centers. The emergency centers in the South Texas regions are considered to have a high potential for trafficking because of the close proximity to the U.S.-Mexico border.
A descriptive survey design was used to collect the information to identify current practices. The study used a brief survey of 23 questions developed by the nurse researchers based on a review of the literature and expertise with emergency department processes and care. The survey focused on the type of emergency department (freestanding vs hospital-based), providers, and clinical staff; methods used to screen adult and child human trafficking victims; results including number of positive screens, characteristics of individuals with positive screens, strategies helpful to identify human trafficking victims, and the actions taken following identification.
The list of nurse leaders was obtained by contacting the Emergency Centers and requesting the name, email address, and phone number of the Emergency Center Nurse Leader. IRB approval was obtained prior to deploying the survey from August 15, 2018 to November 15, 2018. The survey was deployed using a sequential set of strategies including an online survey tool, emailed survey, and phone survey. Each sequential data collection method was followed by two reminders in the same format. Participants were informed that participation in the research was voluntary and survey completion indicated consent. In order to promote increased response to the surveys, each nurse leader participating in the survey was entered in a drawing for a gift certificate.
Results: Surveys were completed by 26 of the 99 Emergency Centers in South Texas for a return rate of 26.2%. Nurse leaders responded from each of the five trauma service areas. Of the 26 emergency centers responding, 9 (34.6%) stated that they formally screen adults and 9 (34.6%) stated that they formally screen children to identify human trafficking victims, however only 1 emergency center uses a tool to specifically screen victims of human trafficking. The remainder of the emergency centers stated that patients were not screened to identify whether they were a victim of human trafficking. The emergency centers reported that no adult victims of human trafficking were identified in 2017, and one emergency center reported that 10 child victims of human trafficking were identified in 2017.
Conclusion: The identification of human trafficking victims may be missed when there is no standardization of screening. Emergency Center Nurses are positioned to identify and intervene for human trafficking victims. It is recommended that emergency center healthcare professionals be educated regarding human trafficking victim assessment and formal standardized screening for human trafficking be implemented. Resources to use for victim intervention need to be identified and be readily accessible to the healthcare providers and clinicians working with the individuals identified as victims.