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Jane Doe – Responding to Vulnerable Patients

Many first responders get a call they will never forget or are not mentally prepared for, regardless of how long they have been in the field. For a seasoned paramedic, that call happened in May 2024. With decades of experience in the emergency medical services (EMS) field, he encountered what he believed was his first human trafficking case. 

Unconscious and Alone 

On a beautiful sunny day in the mid-afternoon, an ambulance crew and police officer responded to a call for an unknown and unconscious female child. Once on scene, they approached the young girl, who was wearing a dirty shirt and pajama-type pants. She was lying on her back on the side of the road. She initially was unresponsive to verbal stimuli but had an open airway and pulse. As standard procedure, the paramedic applied painful stimuli to assess the patient’s responsiveness, at which point she moaned and began moving sluggishly. During the patient assessment, the medic observed signs of impairment from some type of substance. To determine proper care, the crew had to ask the child difficult questions related to substance use and sexual activity. With slurred speech, she stated that a man with white hair gave her marijuana and a pill before sexually assaulting her. 

The medic immediately turned to the police officer to confirm that she heard the girl’s statement. The officer also confirmed that she had her body camera on to document evidence from the scene that could protect the patient and the responding personnel. The online medical notification and consultation center linked the information from the crew to the hospital as the crew, accompanied by the officer, transported the patient. 

En route to the hospital, the young girl vomited and faded in and out of consciousness. From a medical perspective, the primary task was to protect her airway, which required suctioning, but there was so much more to this case. Upon arrival, the crew informed the intake nurse of their assessment that the “Jane Doe” was a possible rape or human-trafficking victim. The hospital staff marked the case as confidential. The police officer and investigators took the medic’s statement and collected available evidence, which included her clothing, shoes, and the suction tubing and catheter containing the vomit. 

The Impact on Responding Crews 

The true story of the unconscious and alone girl on the side of the road left the responding crew shaken. Over the years, they had seen a lot of medical emergencies and trauma, but that call was different. After several hours, the sheriff’s office was able to track down the patient’s mother, who lived nearby. Apparently, that 13-year-old girl had run away and was found 20 minutes from her home. While the case is still under investigation, the paramedic wanted to share what he learned and how the crew responded to that call. 

There are many scenarios that first responders hope they never encounter, but what they do in these situations can impact their patients and themselves for the rest of their lives. So, it is imperative to be prepared. In any potential criminal case, providing the best care for the patient includes protecting the scene, evidence, and anything else that can help the patient during the investigation. Thorough patient assessments can dispel unsubstantiated assumptions and provide evidence to properly care for patients and report criminal activity. 

Actions to Protect Potential Victims and Responders 

Whether on duty or off duty, it is important to maintain situational awareness and recognize signs of human trafficking and other criminal activity. In an EMS setting, this is particularly important when assessing patients. For patients who are afraid or unable to speak, it may be easier to assess them through observation than conversation. In any case, it is each person’s responsibility to recognize and act upon the signs of human trafficking and the endangerment of vulnerable patients. Steps to consider for protecting the life, health, and well-being of others include the following: 

  • Maintain awareness of the threat to communities and the associated signs of trafficking (e.g., 88% of human trafficking victims have at least once had access to healthcare during their situation); 
  • Understand EMS protocols for professionals; 
  • With a suspected crime, do not disturb the scene or clean the patient to preserve fluids and other potential evidence; 
  • Involve law enforcement in any potential case and, when possible, have them accompany the patient transport; 
  • When possible, transport to a hospital designated as a sexual abuse and rape assessment center; 
  • Notify the hospital en route and upon arrival that the patient is a potential human trafficking or sexual assault victim to ensure confidentiality; 
  • Clearly document all details of the call – clothing, demeanor, statements, and any other observations – using “the same incident report writing standards for suspected human trafficking cases as they do for documenting other suspected criminal behaviors”;  
  • Report possible human trafficking situations to the National Human Trafficking Hotline; 
  • Remember the four priorities of EMS: self, crew, community, and patient; 
  • Do not let second-guessing hinder the duty to act and report signs of possible criminal activity; and 
  • Seek mental health assistance when needed.  

The paramedic who received that unforgettable call in May offered one more bit of advice, “Remember that we are all human and must be strong and smart. We need to build a strong support system to help us cope after difficult calls.” Combatting human trafficking involves the entire community. EMS and other first responders may encounter more cases than they realize. Training and education can help build observational capabilities to identify signs and report them to the proper authorities while protecting victims, crews, and the community around them. EMS regularly works with other first responders and the broader community to ensure the health, safety, and well-being of victims. This tragic story and its lessons learned are examples of that collaboration. 

Catherine L. Feinman

Catherine L. Feinman, M.A., joined Domestic Preparedness in January 2010. She has more than 35 years of publishing experience and currently serves as editor of the Domestic Preparedness Journal, DomesticPreparedness.com, and The Weekly Brief. She works with writers and other contributors to build and create new content that is relevant to the emergency preparedness, response, and recovery communities. She received a bachelor’s degree in International Business from the University of Maryland, College Park, and a master’s degree in Emergency and Disaster Management from American Military University.

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