SOCIAL EM & POPULATION HEALTH
Identifying Human Trafficking in the ED: Screening and Intervention Strategies
SAEM PULSE | MARCH-APRIL 2025
By Christa Pulvino, MD, MPH, MBA, and Kelli Jarrell, MD, MPH, on behalf of the SAEM Social EM and Population Health Interest Group
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Human trafficking (HT) is defined by the United Nations Office on Drugs and Crime as “the recruitment, transportation, transfer, harboring or receipt of people through force, fraud or deception, with the aim of exploiting them for profit.” Approximately 50 million persons worldwide are victims of human trafficking, generating hundreds of billions of dollars in illegal revenue. The Ohio Human Trafficking Task Force identified over 1,000 people who were being actively trafficked between 2013 and 2018 in Ohio and 4,000 people who were at risk for trafficking. Christa Pulvino, MD, MPH, MBA, was awarded one of two inaugural SAEM Social Emergency Medicine
Research grants to implement a pilot screening and intervention program for HT in the emergency department (ED) at the University of Cincinnati Medical Center. She collaborated with the Early Intervention Program (EIP), a grant-funded organization embedded within the ED, to design and implement the screening program. The program uses the Rapid Appraisal for Trafficking (RAFT) tool, a validated four-item screening tool designed to identify labor and sex trafficking in health care settings. The EIP screens for diseases of public health interest, such as substance use disorders and HIV, and provides linkage to care as well as resources for food insecurity,
housing, and other social needs. The EIP screens approximately 5% of the total ED population, typically composed of high-risk individuals. In the first eight months, the pilot program identified 84 individuals who screened positive for trafficking risk. Many of these patients have been linked to social services compiled through collaboration with social workers and community partners. Data collection continues to describe the broader social needs of this population. One of the key challenges in combating HT is identifying individuals who are being trafficked. The ED is a common entry point to the healthcare system in the United States. As such, trafficked