The Public Safety Group Blog

Human trafficking is a public safety reality that shows up in everyday calls, often disguised as something routine. With an estimated 27.6 million people affected worldwide, the odds are high that EMS and fire crews will encounter victims long before anyone names what’s happening. The question is whether they'll recognize the red flags in time, and know the right way to respond.  

To discuss the realities of human trafficking, the Public Safety Group interviewed David Tan, MD, a board-certified EMS physician and prehospitalist based in the St. Louis, Missouri, area, about what first responders should look for and how to respond. Over 27 years in academic medicine, Dr. Tan served as the founding Chief of EMS at Washington University in St. Louis, overseeing EMS medical control for police, fire, EMS, and specialty response agencies across the region. 

Dr. Tan currently serves as Chief Medical Officer and Medical Director of the Saint Charles County Ambulance District, one of only a small number of full-time EMS medical director roles in the country. Dr. Tan also spent 11 years as a fire department medical director and continues to work directly with EMTs and paramedics in the field. 

What is Human Trafficking? 

Human trafficking involves the abuse and exploitation of people across all ages, genders, races, and backgrounds. It is often overlooked, especially in prehospital and emergency settings where presentations may be subtle or easily attributed to something else. One of the biggest misconceptions is that it only involves commercial sex acts and sex trafficking. In reality, trafficking also includes labor trafficking, and in many cases, victims experience both forms of exploitation. 

EMS and fire professionals play a critical role in identifying human trafficking because victims frequently intersect with emergency care, with some studies showing that as many as 80 to 85 percent of trafficking victims access medical services at some point. These encounters may occur during EMS responses or when patients arrive at emergency departments by private vehicle, but EMS is often the first point of contact. This need for awareness extends across all disciplines, as even routine interactions like law enforcement traffic stops can reveal indicators when responders are attentive.   

For EMS and fire professionals, this creates a unique opportunity to identify and help, but only if clinicians are equipped to recognize the signs and understand what to do next. 

Training and education around human trafficking remain inconsistent across jurisdictions, with wide variation in how clinicians are taught to identify potential victims or respond to concerns. As a result, some providers may hesitate to act or may inadvertently miss opportunities to intervene. Dr. Tan says that even just increasing awareness and demystifying the role of prehospital clinicians are critical steps toward ensuring first responders become part of the solution. 

“One of the biggest things that we can do is just talk about it,” Tan said. 

The Role of EMS Professionals as Mandatory Reporters  

Reporting requirements around human trafficking can be confusing for first responders, and they vary by state. While EMS professionals are mandatory reporters for child abuse nationwide, not every state classifies suspected human trafficking as a required report. Even so, that does not remove responsibility from prehospital clinicians. 

“Even if it’s not a mandatory reporting metric in your state or locale,” Dr. Tan said, “it does not obviate the ethical responsibility of us as professional clinicians to at least report that to the receiving facility or the receiving hospital.” 

For EMS, this means communicating concerns to the receiving hospital and documenting observed indicators appropriately. Prehospital providers rarely have the time, training, or authority to do anything beyond recognition and reporting, and they are not expected to.  

“The rescuing is going to be done by law enforcement,” Dr. Tan noted, “We’re not expecting you to tackle the perpetrator and rescue the victim right away...We just want you to recognize it, approach it, and report it.” 

What EMS Should Look for When Identifying Potential Human Trafficking 

Many of the indicators associated with human trafficking in a healthcare setting overlap with signs EMS professionals already recognize in cases of domestic abuse. Those same indicators often apply to trafficking victims and should prompt closer attention. 

Physical findings are often an initial red flag. Localized trauma, such as injuries to the head, face, neck, abdomen, pelvis, or groin, may raise questions about how those injuries occurred. Visible signs of repeated abuse, including hematomas, bruising, abrasions, or wounds in different stages of healing, are particularly concerning.  

Behavioral cues during the patient encounter can be just as telling. One common indicator is the presence of a companion who insists on staying with the patient at all times. Patients may appear hesitant to speak, or consistently look to another person before responding, as if seeking permission or direction. 

Some signs are more specific to human trafficking. Dr. Tan pointed out cases involving children brought in by adults who are not relatives or legal guardians. The children may be confused, and the stated relationship with their caregiver may change when questioned; for example, an uncle becomes a sibling. These discrepancies, while subtle, can signal a larger issue. 

Control over personal identity and communication is another key red flag. Patients may not have access to their own identification or cellphone. In some cases, patients may carry multiple phones, one of which may be tied to a trafficker or “handler.” 

Dr. Tan notes that it is important to remember that trafficking is rarely identified based on a single sign.  

“It isn’t always just one thing,” he emphasized. “It’s the sum totality of what you’re observing.”  

Why EMS Needs to Use Trauma-Informed Care 

Recognizing potential human trafficking is just step one. How EMS professionals approach patients after recognition can directly impact whether care helps or unintentionally causes more harm. When concerns do arise, Dr. Tan emphasized the need for a trauma‑informed approach. This means approaching patient interactions with the understanding that past trauma may shape how a patient responds to questions, authority, and medical care.  

“You go into your interview with the realization that we don’t want to further contribute to their trauma,” he explained. 

Providers should remember that patients may not recognize themselves as victims, and they may not view the person controlling them as a perpetrator. Language and approach are especially important in cases of suspected human trafficking.  

Dr. Tan advises using open‑ended, nonjudgmental questions such as, “Who are you here with today?” or “Are you able to come and go as you please?” Questions about possession of ID, awareness of location, or even knowing what city or state they are in can reveal concerning gaps.  

“Those are all odd things to not know,” he noted. 

Many victims of human trafficking do not identify themselves as victims, or they may internalize blame for their situation. Depending on their background, age, or circumstances, they may not recognize their situation as trafficking at all.  

Language and tone are critical. Dr. Tan emphasized shifting away from questions that feel accusatory or judgmental.  

“Instead of saying, ‘What’s wrong with you?’ it’s important to use an approach such as ‘What happened to you?’” Open‑ended questions, such as asking what led to the EMS call or emergency department visit, allow patients to speak in their own words and at their own pace. 

Establishing safety and trust is equally important. Many trafficking victims fear law enforcement due to prior criminal history, immigration concerns, or threats made by traffickers. Letting patients know that EMS providers are there solely as medical professionals can lower barriers to communication. Without this foundation, questioning can alienate patients. 

How EMS Can Create Space to Intervene and Assess Safely 

In cases of suspected human trafficking, one of the simplest and most effective ways EMS can intervene is by creating privacy. According to Dr. Tan, separation does not require confrontation or escalation.  

“The thing that works, both in the prehospital setting and the hospital setting, is simply a matter of privacy,” he said. 

Dr. Tan recommends framing the request as a routine part of care. A statement like, “For patient privacy sake, or for HIPAA compliance, I need to do a medical exam in private,” is often all that’s needed. Asking a companion to step away briefly provides a legitimate and familiar reason to separate the patient without raising suspicion. This approach is consistent with standard clinical practice, whether trafficking is suspected or not. 

Once separated, EMS clinicians have the opportunity to ask questions privately, observe behavior, and assess indicators without outside influence. 

Overcoming Discomfort with Addressing Human Trafficking 

For many EMS professionals, discomfort around human trafficking stems from uncertainty rather than unwillingness. When clinicians don’t feel equipped to approach the patient, or don’t know what to do once trafficking is suspected, anxiety naturally follows. 

That uncertainty is often reinforced by inconsistent or absent education. Training on human trafficking varies widely across EMS systems, and in some cases, clinicians receive little to no formal instruction at all. As a result, providers may encounter a potential trafficking situation for the first time in the field without practical tools to guide their response. 

Education is the most effective way to reduce that anxiety. Dr. Tan emphasized that EMS is in a unique position to identify victims because “the vast majority of them will, at some point, encounter the emergency medical system.” 

Practical instruction matters. Giving clinicians specific questions to ask, guidance on how to ask them, and awareness that patients may not even realize they are being trafficked can be a turning point. Dr. Tan described this realization as an eye‑opening moment for many students, and it is one that significantly lowers anxiety in the field. 

Finally, knowing where to take patients matters. When possible, transporting to facilities with strong social work and case management resources can make a meaningful difference. Connecting patients to hospitals equipped to involve social services and law enforcement appropriately supports longer‑term intervention and reinforces that EMS is not handling these situations alone. 

The Impact of Large Events on Human Trafficking 

Large, high‑profile events have long been linked to increased human trafficking activity. While more research needs to be done to determine the impact, there is evidence tying large events to a rise in trafficking rates.  

Events like the Super Bowl, World Cup, large conventions, and other major gatherings create temporary surges in population, demand for services, and anonymity, which are all conditions traffickers exploit. Importantly, this activity is not only limited to commercial sex trafficking; it also includes labor trafficking tied to event‑driven industries. 

As cities host large events, public safety agencies often see increased operational demand across the board. Dr. Tan says this surge represents both a challenge and an opportunity for first responders. 

“That’s the golden opportunity for us in public safety to increase our awareness and be on the lookout for red flags,” he said. “Recognizing the signs of human trafficking at large events can be challenging, but it sure helps if you know a few basic things of what to look for.” 

How EMS Educators Can Teach Human Trafficking  

It's essential to address the topic of human trafficking directly in EMS training. Emergency Care and Transportation of the Sick and Injured, Thirteenth Edition, features a special section on Special Patient Populations, authored by Dr. Tan. This section provides a foundation for human trafficking situations. 

In our discussion, Dr. Tan also encouraged EMS instructors to go further and use scenario-based learning to see how students assess situations, gather information, and react in real time. He noted that one effective approach is to embed trafficking indicators into otherwise routine calls.  

“The best thing is to not even tell the student that that’s what the scenario is,” he explained. For example, a standard chest pain or abdominal pain call can include a caregiver who is unrelated, controlling, or inconsistent, which forces learners to rely on observation rather than expectation.  

This kind of training builds confidence the same way other core EMS skills do. The more students train in interpersonal relationships and information gathering, the faster they become familiar with these areas. Repetition matters, and scenario‑based exposure helps normalize what can otherwise feel intimidating or unfamiliar. 

Dr. Tan also stressed that education cannot stop at the scenario itself. A debriefing allows instructors and students to discuss what went well, what didn’t, and how clinical decisions were made.  

Supporting Responder Mental Health 

Debriefings should also be used to address responder well‑being and normalize the need for support after difficult calls. A comprehensive training program must include resources for responders themselves: access to mental health services, opportunities to decompress, and safe spaces to talk through what they’ve encountered. Without that support, educators risk creating secondary trauma among clinicians who are trying to help others through horrific circumstances.  

Dr. Tan noted that EMS clinicians routinely see people at some of the worst moments of their lives, and trafficking cases can involve particularly distressing details.  

“This constant, repetitive exposure to bad things happening to people takes its own mental health toll on our personnel,” he said.  

That mental health toll can surface in different ways. For some clinicians, it’s the realization that they may have missed signs of trafficking in patients in the past. For others, the toll comes from repeated exposure once awareness increases. 

“Once you recognize it, once you know what to look for, and you hear their stories and realize the horrific circumstances they’re living under—that can affect your mental health too,” Dr. Tan noted. 

Peer support and access to mental health resources help address both dimensions. Dr. Tan emphasized the importance of remembering that while clinicians can’t change the past, training and awareness can empower them moving forward.  

“There’s nothing I can do about the people I’ve missed,” he said, “but from this point forward, I can be the one that recognizes the problem and helps get the patient the support they need.”