Jan. 27, 2026
Human trafficking is a complex and pervasive issue that often goes unrecognized in healthcare settings. As Cree D. Kachelski, M.D., notes: "There's a lot of fiction out there about what a victim may look like or how a victim may present in the emergency department. Not all trafficking victims are women, or people without ID or someone with a drug issue."
Both Dr. Kachelski, a pediatric and emergency medicine physician and child abuse physician at Mayo Clinic in Rochester, Minnesota, and Andrea White, a Safe Harbor regional navigator, emphasize that trafficking includes both labor and sexual exploitation and that stereotypes hinder proper identification.
Understanding trafficking dynamics
Dr. Kachelski and White outline some key dynamics to bear in mind related to victims of trafficking who may enter a trauma center for care.
Adult victims
Trafficking can occur in many settings. Adults may be exploited in massage parlors, restaurants or through forced criminality. Online platforms and venues such as exotic dancing and strip clubs also are common sites of exploitation.
Child and adolescent victims
Children often traffic themselves without knowing or understanding what they are doing is trafficking. For adolescent victims, a third party traffics them 30% of the time.
Family members also may be involved in trafficking.
"A biological parent victimizes 8% of all children in these circumstances," says Dr. Kachelski.
Unhoused youth are especially vulnerable, and 70% of them self-traffic to meet basic needs, exchanging sex for food, shelter or goods.
"Children may allow themselves to be trafficked just because they want those cool shoes — those Air Jordans — to not be bullied in school," she adds.
Children cannot legally consent to any sexual activity, including sharing explicit photos or performing, according to Dr. Kachelski. Because their brains have underdeveloped risk-assessment regions and overdeveloped pleasure-seeking areas, combined with a strong desire for peer acceptance, adolescents face significantly higher risk levels.
"Children's prefrontal cortexes aren't ready to balance the risk," she says. "They use peers to get input and have a desire for acceptance. All this is a setup for risky behavior."
Polyvictimization
A recurring pattern, according to White, is polyvictimization — many victims have been trafficked previously and may reference prior traffickers.
Clinical indicators and assessment
Victims of human trafficking rarely disclose their status in trauma centers, says White.
Instead, clinicians should look for the following indicators for adults:
- Physical harm, such as evidence of strangulation, sexual assault or multiple assaults.
- Neglected maintenance care.
- Requests for STI treatment, sexual assault nurse examiner exams or pregnancy care.
- Mental health concerns.
- Heavy dependence on a cellphone during care, urgency to leave, or a companion controlling the patient's narrative or access to personal items.
Dr. Kachelski notes that the indicators for children parallel some of those for adults, such as requests for STI treatment, sexual assault nurse examiner exams or pregnancy care, or mental health concerns.
She also underlines one tool that can be particularly helpful.
"A critical step toward identifying trafficking victims and getting them assistance is carefully taking the patient's history," she says.
For pediatric patients, Dr. Kachelski emphasizes that it is crucial to speak with the child alone.
She also notes: "With kids I think are victims of trafficking, I try to get details about things, such as what partners they have had and how old the partners were. And if there are enough concerns for trafficking, I will just ask, "Have you traded sex for something?'"
A history of child maltreatment is a significant risk factor for trafficking.
Responsibilities of trauma professionals
Human trafficking victims can present at any trauma center, including rural areas where traffickers may hope to operate covertly.
"It's actually more important to watch for victims in rural areas, because traffickers know these may be places to avoid detection," says White.
Mandated reporting
Trauma professionals are mandated reporters to law enforcement, the FBI and child protective services when trafficking is suspected. After stabilizing medical needs, these agencies can assist with victim safety.
Recommended actions:
- Separate the patient from accompanying individuals, using hospital security if needed to obtain needed medical information.
- Ensure decision-making autonomy.
- Provide resources for trafficking victims and survivorship.
Discharge planning:
When discharging adult victims, ask:
- Are your needs met?
- Do you have a safe place to go?
- Where will you sleep tonight?
Healthcare system considerations
Contrary to common belief, most trafficking victims seek medical care; 88% have visited emergency departments in the six months prior to being identified as a victim. However, many victims go unrecognized due to insufficient training and inaccessible information.
"It's not that they haven't sought care, but healthcare professionals don't know if they are seeing them," says White. "Overlooking this isn't intentional, but information they'd need to identify trafficking victims is often inaccessible."
Medical education rarely addresses trafficking, though Mayo Clinic now offers a module on abuse. Screening tools may aid identification, but detection often occurs after significant harm. Patients who are trafficking victims require specialized care for injuries, chronic conditions, STIs and trauma-informed support. All need trauma-informed care.
Key takeaways for medical professionals
- Remember that human trafficking victims can present in any healthcare setting and may not fit common stereotypes.
- Maintain a high index of suspicion, especially when clinical or behavioral indicators are present.
- Take a thorough history, talk with pediatric patients privately, and inquire directly about risk factors.
- Fulfill mandated reporting obligations and ensure victims have access to safety and resources upon discharge.
- Advocate for improved training and screening tools within your institution.