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Part 5: Red Flags and Assessing the Scene

Red Flags

The best way for EMS personnel to recognize trafficking is to be alert to the people and the circumstances of each emergency call. There are warning signs or red flags that EMS personnel can look for, described below. These signs can (but do not always) signify trafficking.

Click on each red flag to review specific examples below:

  1. Tattoos of names, phrases or monetary symbols (i.e. crowns, money bags, barcodes, dollar signs)
  2. Brands or intentional scarring in deliberate patterns
  3. Mentions of significant debt
  4. Paranoid behavior (i.e. will not allow someone to walk behind them)
  5. Anxiousness when talking to EMS personnel
  6. Owns expensive or high-end goods, or is groomed (i.e. hair, nails) in a way which they could not afford on their own
  7. Carrying many condoms on their person
  8. Always accompanied by a third party (particularly in individuals whose first language is not English)
  9. Mentions of living with a large number of people who are not family
  10. Very limited knowledge of the area in which they live
  11. Not carrying personal identification
  12. Inconsistencies in explanations of circumstances or events

Obtaining More Information to Assess the Scene

When EMS personnel are alert to their surroundings, they may suspect that an injured person is a victim of human trafficking. When this occurs, a trauma-informed approach is recommended.

Trauma Dynamics

Victims of human trafficking have suffered terrible trauma. Physical and sexual violence, psychological abuse, deprivation of basic necessities, and constant threats are often daily traumas.

Such trauma can make victims appear withdrawn, shut down, angry, or unresponsive to questions. These are all normal responses to trauma.

The U.S. Substance Abuse and Mental Health Services Administration compiled a description of some of the possible trauma responses a victim may have to human trafficking. They are described below:

  • Being trafficked often takes away a victim’s sense of safety, ownership of their own body, and self-esteem
  • Victims often blame themselves and perceive themselves as damaged or “bad”
  • Victims may feel helpless and out of control
  • Some victims see other people as threats and shut down any interpersonal connection
  • Some victims have difficulty regulating their emotional states and have somatic symptoms as a result. These symptoms are often referred to as “complex trauma” or “complex PTSD”
  • Some victims may have “trauma bonding,” and feel a sense of attachment with trafficker
  • Many victims feel trapped even after they have escaped

Trauma Informed Approach

It is important that the EMS personnel take a trauma-informed approach when helping individuals who are suspected of being human trafficking victims. Being trauma-informed means many things for EMS, who work to do the following:

  • Do understand the far-reaching impact of trauma,
  • Do actively ensure that the victim is not re-traumatized during assessment or treatment,
  • Do be sure to communicate clearly, without jargon,
  • Do sit down or squat to be at eye level with the person who has been injured,
  • Don’t use words like “abuser” or “perpetrator” because it could be a beloved parent or relative who committed the crime,
  • Don’t blame the victim,
  • Don’t become unnecessarily impatient,
  • Don’t speak with a raised voice,
  • Don’t pressure a victim to provide more information. Instead, use sensitive questioning, described below.

Law enforcement officers and investigators can conduct thorough investigations later in a trauma-informed manner. However, EMS may be able to elicit some information by asking a few questions in a sensitive and patient manner.

Sensitive Questions

If EMS personnel suspect that they are seeing someone who is being trafficked, it may become necessary to gently ask for more information. There are certain questions that can help EMS personnel obtain more information. Remember that victims are not likely to speak openly in the presence of traffickers.

Questions to Ask

How to Contextualize Answers

Living Environment

  • Can you tell me about where you live?
  • Where do you eat and sleep?
  • When did you get the tattoo (if visible)? What does it mean?

Look around the scene. Victims of trafficking are often forced to live in the same place they work (such as in restaurants, motels, etc.) and often have their movement restricted by the trafficker. Minors are often not allowed to play with other children. Additionally, traffickers may lie to the victim about where they are or move them so often that they are unable to orient themselves to their surroundings or establish relationships.

Family and Friends

  • Does your family live with you?
  • How often do you get to visit/speak with family or friends?
  • Who do you live with?
  • Are there friends you spend a lot of time with?

Traffickers often isolate victims and keep them away from their family and friends.

However, traffickers can also be relatives or people who were once family friends.

Listen to what the person says: does he or she seem to be able to control his or her own life? Is he/she able to make decisions on his/ her own?

State of Mind

  • Has anyone threatened you or made you feel unsafe?
  • Did someone tell you what to say today?

Traffickers often physically or mentally harm victims. In addition, traffickers will threaten the victim’s family if he or she is not compliant. In some cases, the victim’s parents may have instructed the victim to listen to the trafficker in order to work and send money home. Victims from outside the United States may also be threatened with deportation.

School and/or Work

  • Where do you go to school? What is it like?
  • Do you work? Where are you working now?
  • Who keeps track of the money you earn?

Victims of human trafficking typically are told that they are working off a “debt,” and are not allowed to attend school.

Victims may have a history of truancy or a habit of acting out in class. In cases where the potential victim mentions work, the way the victim is compensated (if at all) and a lack of monetary control can be evidence of trafficking.

Do not use words like “call girl” or “pimp” or “trafficking” or “escort.”

Do not use judgmental terms: remember, victims of trafficking are victims of a serious crime.

DO NOT confront or antagonize a suspected trafficker.

Instead, follow your agency’s procedure. If you feel threatened, go to safety and contact law enforcement immediately.

Sponsored by the

The Human Trafficking Project was supported by Award No. VF004 awarded by the Office for Victims of Crime, Office of Justice Programs, Sponsored by the Institute for Family Violence Studies and the State of Florida.