EMS Refresher Course January 19, 2018

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Ferdinand Stephens
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1 EMS Refresher Course January 19, 2018

2 Difficult to detect Human Trafficking Victims Different demeanor Victims are not willing to disclose right away or at all Everyone responds to stress & trauma in a different way Surrounding circumstances at scene Language barriers

3 Understand the brain during trauma Define Human Trafficking, sexual assault, and rape Identify the potential victims Recognize the warning signs or red flags

4 Loss of prefrontal cortex in brain Determines where to direct attention & thoughts Regulates emotions & intensity of them Stops automatic responses & habits High stress chemicals shut it down Poor attention control Illogical thinking Loss of values Loss of emotional response

5 Freeze Flight or Fight Impaired flight & fight Dissociation: protective measure where disconnection occurs from overwhelming/overpowering sensations & emotions. Spaced out, can t remember Feelings of disconnection Watching as if in 3rd person Tonic Immobility: verbal immobility, trembling, muscular rigidity, insensitivity to intense or painful stimuli Couldn t move, tried to talk but nothing came out Felt numb

6 Human Trafficking means participating in a venture to recruit, harbor, transport, supply provisions, or obtain a person for any of the following purposes: a. Forced labor or service that results in involuntary servitude, peonage, debt bondage, or slavery. b. Commercial sexual activity through the use of force, fraud, or coercion (Iowa Code). Sex trafficking is a form of modern-day slavery in which individuals perform commercial sex through the use of force, fraud, or coercion (NHTRC). Minors under the age of 18 engaging in commercial sex are considered to be human trafficking victims, regardless of the use of force, fraud, or coercion (NHTRC).

7 Men, women, children, LGBTQ (Lesbian, Gay, Bisexual, Transgender, Questionable), foreign & US citizens Vulnerable populations Mental disabilities Runaways Youth Homeless Domestic violence/sexual assault victims War victims

Someone else is speaking for the patient Not aware of current location, date, time, or surroundings Fearful, anxious, PTSD, submissive, tense Signs of physical/sexual abuse, medical neglect, or

8 Someone else is speaking for the patient Not aware of current location, date, time, or surroundings Fearful, anxious, PTSD, submissive, tense Signs of physical/sexual abuse, medical neglect, or torture Reluctant to explain an injury or inconsistency in their story Have possessions that they normally wouldn t have Not dressed appropriately for current weather Dressing older/younger than stated age

9 Average age of entry into prostitution is years old in US (ASPE) Present with non-guardian or unrelated adults Has things that normally they couldn t afford (ex-ugg boots, multiple cellphones, coach purse) Extremely familiar with sexual terms & practices High number of sexual partners Skipping school or frequent episodes of running away Hesitant to talk about particular tattoo Fearful attachment to cell phone (can be used as tracking device)

10 Meet through friends, social media sites, or approached by trafficker Sometimes given false promises like modeling jobs Fake advertisements for businesses, online ads, escort services, truck stops, hotels/motels, on the street

11 2014 about 1 in 6 runaways were likely sex trafficking victims (National Center for Missing & Exploited Children) 87.8% of victims encountered some form of health care in a study of 98 Human Trafficking Victims (Beazley Institute for Health Law and Policy, Loyola) 2017 National Human Trafficking Hotline had 105 calls in Iowa 42 Human Trafficking cases reported Sex trafficking 33 Labor trafficking 4 Sex & labor trafficking 3 Unspecified <3

12 Physical-headaches, memory loss, GI problems, chronic pain, fractured bones, head/neck trauma, infectious diseases, STIs, dental/oral problems, respiratory illness, unhealthy weight loss Pregnancy, PID, other gynecological problems Mental-PTSD, mood disorders, anxiety disorders, dissociative disorders,& substance abuse issues. (Lederer & Wetzel 2014)

13 Anywhere School setting Parties Big events-concerts, Drake Relays, JDC I-80 truck stop Hotels/motels off truck stop Farms Big factories in small towns Small businesses-nail salons, massage parlors

14 Patients fearful to speak with friend/partner/adult/supervisor around Dressed in clothing not matching current weather conditions Injuries inconsistent with story of how they occurred Appear malnourished, signs of abuse, repeated exposure to chemicals Not in control of ID, cell phone, or personal belongings

15 Sexual assault is any type of sexual contact or behavior that occurs without consent of recipient Forced sexual intercourse, forcible sodomy, child molestation, incest, fondling, & attempted rape Rape is penetration of vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without consent

16 1 in 5 women & 1 in 71 men will be raped in their lifetime 63% of sexual assaults are not reported Only about 12% of child sexual abuse is reported College Campuses 1 in 5 women & 1 in 16 men are sexually assaulted Children 1 in 4 girls & 1 in 6 boys will be sexually assaulted before age 18 years old 96% of abusers of children are male 76.8% abusers of children are adults

17 No typical presentation Withdrawn Poor eye contact Crying Guilt & shame Humor Anxious Angry

18 No injuries Bite marks Breasts, neck Bruising Upper arms, inner thighs, neck, wrists, ankles Lacerations/tearing Posterior fourchette, fossa navicularis Physical assault injuries Illuminating substances Potential for DNA on clothing Preserve if possible Drug facilitated High risk for infections & pregnancy

19 Intimate partner/friend No other way of life Debt to be repaid Threats of harm & abuse Identification/passports withheld Traumatic event

20 Poor eye contact, withdrawn, PTSD, anxious Disheveled clothing, missing clothing, unbuttoned pants, clothing laying around scene Altered level of consciousness Substance abuse, intoxication Hesitancy to disclose assault Dressed in clothing inconsistent with current weather Bruising, lacerations Red secretions under where victim was laying

21 Medical Screening Exam Victim Advocates Offered Sexual Assault Evidence Kit Treatment for sexually transmitted infections & pregnancy Law Enforcement DHS

22 Be aware that anyone can be a victim Can be anywhere Look for warning signs or red flags Ask questions & observe the scene Do not be judgmental about appearance or situation Tell them they are safe or they will be taken somewhere safe Report what you see to hospital staff or Law Enforcement at scene Hospital staff may not be able to make a report based on information given but may be able to guide patient care

23 National Human Trafficking Hotline or text Iowa Helpline or text IOWAHELP to Family Resources Safe Path Braking Traffik Law Enforcement

24 Lethargic female under the age of 18 is brought into the Emergency Department by her fiancé who appears older than the patient Fiancé cannot accurately give Jane Doe s full name, birthday, or medical history Medical staff dresses Jane in a hospital gown & notices she has on child like undergarments

25 Female under the age of 18 years old is brought into the Emergency Department by family Family is concerned about Jane Doe Jane has been skipping school & leaving her home for days at a time When Jane comes home she sleeps then leaves again

26 Jane Doe in her twenties is brought to the Emergency Department by EMS from a house party Jane is intoxicated, crying, & is unaware of what is going on EMS talked to people at the scene that stated Jane was drinking with a group of people & went to the bathroom Jane was found on the floor with her pants unbuttoned

27 Jane Doe a 15 year old with a history of depression to the Emergency Department for suicidal thoughts EMS reports Jane & her mother were arguing on scene Jane is yelling at medical staff & states she doesn t care what happens to her because nobody cares about her Jane is refusing to cooperate with medical staff & refuses to discuss events on scene

Alpert, E.J., Ahn, A., Albright, E., Purcell, G. Burke, T.F., Macias-Konstantopolous, W.L. (2014). Human trafficking guidebook on identification, assessment, and response in the health care setting.

28 Alpert, E.J., Ahn, A., Albright, E., Purcell, G. Burke, T.F., Macias-Konstantopolous, W.L. (2014). Human trafficking guidebook on identification, assessment, and response in the health care setting. Boston, MA: Massachusetts General Hospital and Massachusetts Medical Society. Iowa Code, 710A-1. Lederer, L.J. & Wetzel, C.A. (2014). The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals of Health Law, 23 (1), p Retrieved from Consequences-of-Sex-Trafficking%20-.pdf National Human Trafficking Resource Center. Identifying victims of human trafficking: what to look for in the health care setting. Retrieved from %20a%20Medical%20Exam%20-%20FINAL%20-% docx.pdf National Sexual Violence Resource Center. (2015). Statistics about sexual violence. Retrieved from U.S. Department of Justice. (2017). Sexual assault. Retrieved from Williiamson, E., Dutch, N.M., & Clawson Caliber, H.J. (2010). Medical Treatment of victims of sexual assault and domestic violence and it s applicability to victims of human trafficking. Retrieved from

BEHAVIORAL EMERGENCIES

LESSON 21 BEHAVIORAL EMERGENCIES 21-1 Behavioral Emergencies Process of giving first aid may be complicated by victim s behavior Many injuries or illnesses can cause altered mental status or emotional