ED nurse and trauma care specialist Matthew Howard discussed warning signs and red flags for human trafficking.
Would you notice the warning signs of a patient being abused, trafficked or dealing with a predatory situation? Learning what to look for and how to intervene can radically change the outcome for victims. Matthew Howard, DNP, RN, CEN, TCRN, CPEN, CPN, FAEN, FAAN, an emergency nurse at Deaconess Gateway Hospital in Newburgh, Indiana, and faculty member at Northern Kentucky University’s School of Nursing, presented scenarios and solutions during yesterday’s session “Red Flags & Gut Feelings (When Something Just Doesn’t Feel Right): Recognizing Vulnerable Patients.”
With co-presenter Jacqueline Burgdorf, BS, RN, SANE-A, EMT-B, the team lead at Deaconess Gateway Hospital ED, sidelined with a COVID-19 infection, Howard delivered the duo’s information to an engaged audience. At times emotional, he recounted patients whose traumas he easily could have missed had he not been as attuned to the situation as he was, and urged participants to sharpen their powers of observation.
“A missed opportunity is a missed change to interrupt that ongoing harm,” Howard said, adding that studies have shown anywhere from 28 percent to 88 percent of trafficking victims have contact with a health provider during their abuse. The reason for such a disparity in the percentages is that many of these contacts are never documented or reported.
Howard recalled a teenage girl who presented to the ED multiple times, first with abdominal pain and then urinary symptoms, always accompanied by an older “boyfriend” who answered questions for her. On her third visit, realizing something was off, Howard told the man he could not accompany the girl to the ultrasound room. Once there, he learned the girl was in an unsafe situation but had nowhere else to live.
Another time, Howard treated a toddler who had fallen off the couch. The child had a spiral femur fracture, which requires a certain degree of force and twisting not typically seen after a fall of this type. Howard admits he almost let it go due to his heavy patient load and the fact that the child was consolable. Then the child flinched even before Howard touched his leg, looking toward his mother as if checking that it was okay to react.
Attendees packed in to hear Matthew Howard talk about the subtle warning signs of abuse, neglect and trafficking in patients.
Underscoring the need to look closely at subtle signals is the sheer prevalence of abuse. Statistics indicate 20 percent of women experience rape or attempted rape, as do 1 in 31 men.
More than 480,000 people aged 12 and older are victims of rape or assault annually.
Key signs to look for when thinking about abuse are bruising, injuries in various stages of healing, and genital trauma and STIs in children. If a story shifts between triage, exam and reassessment, take note. Check for signs of neglect: malnutrition, dehydration, poor growth, inappropriate clothing and inadequate supervision. Branding or tattoo markings on young children should trigger immediate concern, as should anyone who doesn’t know their location or address.
Ultimately, duty to protect should trump confidentiality rules if there’s even a smidgen of doubt.
“There’s been no malicious prosecution in any way, shape or form if [nurses have] told, if they’ve had a question, if they’ve reported,” Howard said. “The biggest issue is if they don’t.”