Makini Chisolm-Straker

Health Care and Human Trafficking: We are Seeing the Unseen.

Abstract:Objectives. This study aimed to build the evidence base around human trafficking (HT) and health in the U.S. by employing a quantitative approach to exploring the notion that health care providers encounter this population. Furthermore, this study sought to describe the health care settings most frequented by victims of human trafficking. Methods. This was an anonymous, retrospective study of survivors of U.S.-based human trafficking. Results. One hundred and seventy-three participants who endured U.S.-based human trafficking were surveyed. The majority (68%, n=117) of participants were seen by a health care provider while being trafficked. Respondents most frequently reported visiting emergency/urgent care practitioners (56%), followed by primary care providers, dentists, and obstetricians/gynecologists (OB/GYNs). Conclusions. While health care providers are serving this patient population, they do not consistently identify them as victims of human trafficking.

Altered and unstable: wet beriberi, a clinical review.

BACKGROUND Undifferentiated altered mental status and hemodynamic instability are common presenting complaints in the Emergency Department (ED). Emergency practitioners do not have the luxury of time to perform sequential examination, history, testing, diagnosis, and treatment. Rather, we do all of these things at once to save lives and decrease morbidity. An important diagnosis to consider and upon which we can easily intervene is that of thiamine deficiency. OBJECTIVES We present a case of an altered and unstable woman who presented to our busy ED and had rapid improvement after the administration of vitamin B1. We discuss the presentation, pathophysiology, consequences of missed diagnosis, and management of this disease process. CASE REPORT A middle-aged woman presented to our ED with unstable vital signs and an alteration in her mental status. She was unable to provide a history. Empiric treatment with thiamine resulted in the resolution of her hemodynamic instability and improvement in her mental status. CONCLUSION Our patient benefited from the swift administration of thiamine and illustrates the importance of thiamine administration in the altered or hemodynamically unstable emergency patient with an elevated lactate.

Public Health Research Priorities to Address US Human Trafficking

The article discusses the authors call for U.S. public health research to prioritize the issue of human trafficking prevention, and it mentions Americas Trafficking Victims Protection Act of 2000 and the various investigations into suspected human trafficking that were opened by the U.S. Department of Homeland Security and the nations Department of Justice in fiscal year 2015. The health consequences of human trafficking are examined, along with reproductive health and mental health.

Transgender and Gender-Nonconforming Patients in the Emergency Department: What Physicians Know, Think, and Do

Study objective We explore self‐reported knowledge, attitudes, and behaviors of emergency physicians in regard to the care of transgender and gender‐nonconforming patients to identify opportunities to improve care of this population. Methods From July to August 2016, we electronically surveyed the American College of Emergency Physicians’ Emergency Medicine Practice‐Based Research Network of 654 active emergency physician participants. We performed frequency tabulations to analyze the closed‐ended response items. Results Of the 399 respondents (61% response rate), 88.0% reported caring for transgender and gender‐nonconforming patients in the emergency department (ED), although 82.5% had no formal training about this population. The majority of physicians (86.0%) were comfortable asking about personal pronouns. Only 26.1% of respondents knew the most common gender‐affirming surgery for female‐to‐male patients; 9.8% knew the most common nonhormone gender‐affirming medication that male‐to‐female patients use. Almost no respondents (<3%) were aware of emergency medicine practitioners’ performing inappropriate examinations on transgender and gender‐nonconforming patients. Conclusion Although transgender and gender‐nonconforming people represent a minority of ED patients nationwide, the majority of respondents reported personally providing care to members of this population. Most respondents lacked basic clinical knowledge about transgender and gender‐nonconforming care.

Rothman et al. Respond

lacking. Moreover, a review of psychological interventions from 1990 to 2015 found no primary research studies investigating the efficacy of psychological therapies for victims of trafficking. Therefore, we recommend adding a sixth priority to Rothman et al.’s “proposed agenda for public health research on human trafficking”: implement and evaluate posttrafficking long-term, trauma-sensitive health care services for victims of human trafficking. To achieve this goal, health care institutions will need to initiate or expand trauma-sensitive care training programs for employees involved in patient care. Health care professionals and researchers are responsible for more than identification of and emergent response to trafficked patients; they must advocate, administer, and evaluate the efficacy of long-term trauma-sensitive care.

Measured steps: evidence-based anti-trafficking efforts in the E.D.

Human trafficking was defined in the United States in 2000, with the Trafficking Victims Protection Act (TVPA). Studies demonstrate that clinicians are seeing trafficked persons and emergency departments (ED) are among their most frequented healthcare sites.,, These studies were of survivors reporting their healthcare experiences while being trafficked, some of which occurred before the TVPA; EDs have been serving trafficked persons as patients long before the government named the problem. This is not surprising. We care for those affected by all kinds of interpersonal trauma, including intimate partner violence (IPV), gun violence, elder abuse, and child maltreatment. This article is protected by copyright. All rights reserved.

A Theory Based Didactic Offering Physicians a Method for Learning and Teaching Others About Human Trafficking

Emergency clinicians are on the frontlines of identifying and caring for trafficked persons. However, most emergency providers have never received training on trafficking, and studies report a significant knowledge gap involving this important topic. Workshops often employ a “train‐the‐trainer” model to address clinicians’ knowledge gaps involving various topics (including trafficking). By offering participants knowledge and skills needed to both understand relevant content and teach this content to future learners, this model aims at promoting widespread dissemination of essential information. However, current train‐the‐trainer workshops typically involve full or multiday sessions and employ multimodal instructional techniques, making them time and resource intensive for both participants and facilitators.

Primary trauma care curriculum: A qualitative analysis of impediments to improvement

Objectives In 2014, the primary trauma care curriculum was delivered at a national trauma center in San Salvador, El Salvador. A quantitative analysis demonstrated that subsequent incorporation of primary trauma care algorithms did not occur. The purpose of this qualitative analysis is to explore why the delivery of the primary trauma care curriculum did not have a measurable effect on provider observance of primary trauma care algorithms. Methods Key informant interviews of primary trauma care instructors and students, trauma care observers, and hospital administrators involved in the delivery of the primary trauma care curriculum were conducted in February 2015. Interview transcripts were analyzed qualitatively using a grounded-theory approach and thematic analysis for insights and common themes. Results Four common themes emerged to explain why adherence to primary trauma care algorithms did not improve: Primary Trauma Care course delivery problems, insufficient equipment, insufficient nurse training, and unsystematic team response. Conclusions Despite the delivery of the primary trauma care curriculum, adherence to the primary trauma care algorithms did not improve as a result of problems integral to the primary trauma care model—including the teach-the-teachers method of curriculum dissemination—as well as local conditions at this hospital. These findings suggest that an isolated educational intervention may not be successful unless the host institution is able to commit to the implementation of the educational material in an ongoing and comprehensive fashion.