When Chief Patty Dukes of Honolulu EMS received an invitation to a Pacific Alliance to Stop Slavery (PASS) event, she had no idea what she was in for.
But after hearing Kathy Xian, an actual human trafficking victim, speak about the human trafficking problem and the estimated 600 Thai workers already trafficked into Hawaii and Washington, she knew her EMS system needed a protocol to help.
“I was stunned — I had no idea,” said the 33-year Honolulu resident. “Many of us didn’t know [human trafficking] existed here or had the wrong idea about it.”
So Chief Dukes invited Xian to talk to her department’s supervisors in January of this year and then to return over the summer to present to all her personnel.
“All emergency responders need to get this training,” she said.
This training incorporated elements to help EMS providers not only recognize victims of human trafficking but also offer information to get them to safety.
“It was the best lecture we’ve ever had,” said paramedic Maile Lambeth. “For the first time we felt we were there for a reason and could use the skills out on the road.”
The protocol
The orientation, which Chief Dukes said will be repeated each time new paramedics are added to her staff, begins with a basic introduction to human trafficking, what it is and how it works. But it can’t end there.
“It’s less a benefit to EMS than to the victims,” Chief Dukes said. “A lot of our job is customer service.”
The age and gender of the patient could be one of the biggest distinctions providers need to make, Chief Dukes said, because the line between prostitution and human trafficking can be blurry. Many are underage girls from abusive homes, often runaways, who may be lured into the world of human trafficking by a trusted relative or family friend.
There are also the injuries. Black eyes and traumatic alopecia are common, as is a patient being beaten everywhere except the face.
Yet another concern is bystander involvement. Others may claim to be the patient’s relative or friend, but in actuality, Chief Dukes said, they are there to intimidate the patient and ensure nothing incriminating comes up.
“The women are so brainwashed and abused that they’ll do anything to avoid beatings,” Chief Dukes said.
So in the case of a suspected trafficking victim, Honolulu EMS allows no one in the ambulance but the patient and the provider.
“My no. 1 rule is that nobody else comes in,” Lambeth said.
The protocol includes a code word for suspected victims and notification of the ED that a pimp or otherwise dangerous person might come looking for the patient.
“We use terminology to let them know that we know they’re ‘in the game,’” Chief Dukes added.
“We’re taught patience and a way of speaking to let them know I’m not judging them,” Lambeth said.
Out of the field
Setting such a patient up with information for contacting PASS is the next link in the chain. Providing care in the field is important, but when Honolulu EMS plays a hand in getting one of these patients off the street and into a safehouse, where they’re getting care to recover, the department refers to it as a “save.”
“We care for their injuries and rescue them from the life they’ve been held to,” Chief Dukes said.
Outside the protocol, Honolulu providers are also working with PASS to raise awareness and provide solutions — lobbying for legislation to decriminalize victims, for example.
Educating children at risk for becoming human trafficking victims is another important step toward resolution.
“One victim was picked up at my son’s school,” Chief Dukes said.
In practice
Lambeth, who spent eight years on the midnight shift in Waikiki, said she gets a lot of calls regarding fights among victims or abuse from a pimp.
“In our department, I probably have dealt with [human trafficking] the most,” she said. “It’s hard, like dealing with a child.”
The most frustrating thing for providers encountering human trafficking victims, she said, is that they often won’t reveal any information at all — they’re either afraid or brainwashed.
“We have to achieve a different level of trust so they can give us information,” Lambeth said. “If they do want to reach out for help, we can assist them with that.”
What you can do
Chief Dukes admits that not every system thinks it has the time or the budget to conduct this kind of training, but she says it’s worth it.
“With one save, you get it,” Chief Dukes said. “It’s a small part of what we do, but it offers a huge benefit.”