On a snowy, bitter cold morning Dec. 7, Elli Reid stood before a crowd of some 60 people at University of Colorado Hospital. Her chilling subject matter matched the weather outside.

Reid, a detective with the Colorado Springs Police Department, was there to discuss the subject of human trafficking – exploitation of individuals by others for sex, forced labor, and slavery. She spoke frankly in her introduction.

“This is a harsh, sexually explicit topic,” Reid said. “I don’t want to take away from that and make it vanilla.”

The talk was peppered with graphic images, abusive language and frank discussions about a robust underground economy that trades in flesh and thrives on fear and intimidation, both physical and psychological. It’s alive and well in Colorado and across the United States and the world, said Reid. She is part of a Human Trafficking Unit formed in the Colorado Springs Police Department that launched in 2014.

“We’re staying busy in Colorado Springs and El Paso County,” Reid said. She added that UCH sits in an area ripe for human trafficking. “You have I-25 running north-south and I-70 running east-west right through lovely Denver,” she said.

Violating the vulnerable

The potential victims are also here: young runaways, the physically abused, the homeless, and the forsaken, all targets for those who prey on the vulnerable by offering a rough security in exchange for servitude, Reid said. The trade bustles in the motels, massage parlors, brothels, and strip clubs that dot any urban area. But Reid said that human trafficking often hides in plain sight and is present on the streets and in schools and neighborhoods.

Reid came at the invitation of Eve Lindemann, RN, CCRN, trauma nurse coordinator at UCH. Lindemann heard her speak at UCHealth’s Memorial Hospital in Colorado Springs, which has a well-established and respected Forensic Nurse Examiner (FNE) program to identify and assist victims of violence, including those caught up in the web of human trafficking.

“I thought it would be good for our trauma staff to increase their awareness of the importance of helping these victims,” Lindemann said.

The hospital has taken another step in that direction with the recent hiring of Santasha Gordon, RN, as its first SANE (sexual assault nurse examiner). Gordon served in the role for three years at Denver Health. The job involves examining potential victims of sexual violence, collecting evidence, providing counseling and medical care, and working with law enforcement. Gordon said she hopes to launch the program, including nurse training, in the next several weeks.

Before our eyes

The human trafficking presentation is important for bedside nurses, who can help spot signs of trouble when a patient shows up for a medical issue: tattoos, brands, fidgeting, anxiety, inordinate attention to the cellphone, and so on, Gordon said.

“We don’t like thinking this is in our own backyard, but we all need to be aware that it happens,” she said.

Lindemann recalled an incident when she worked as a bedside nurse in the Burn Center. She encountered an attractive woman of about 20 with two older men who wouldn’t leave her side. The relationship “didn’t seem normal,” Lindemann said. “But I wasn’t sure who to call or how to respond and I didn’t know the questions to ask,” she said.

The FNEs play that role at Memorial, not only for providers, but also for the police. “The FNEs are key to the work we do because they are trained in recognizing the signs of human trafficking,” Reid said. They act as “subject matter experts” who both treat victims and testify about the evidence they collect, she added. “I have them on speed dial.”

Mind of the victim

It’s vital for providers not only to recognize the physical signs of human trafficking victims but also to understand the psychological damage of the crime, Reid said. She noted to the audience that she learned early never to ask a victim, “Why don’t you leave this life?” It’s a question fraught with judgment and disapproval. Rather, a provider should ask, “What keeps you here?” That opens the door to discussion and understanding of the factors that have led them down a path that Reid stresses no one chooses voluntarily.

Reid labeled pimps sexual “puppeteers” with a “controlling mindset” they use to maintain stables of prostitutes, euphemistically called “escorts.” She showed an example of an ad she placed on an online site that used thinly disguised wording to solicit sex for $100 a half hour. It didn’t take long for her phone to “blow up” with inquiries, Reid said, noting that at that rate, an escort could easily earn $2,500 a week, but a pimp would take at least a portion of it, if not all.

For that reason alone, Reid dismissed the notion that the prostitution that is part and parcel of human trafficking is a “victimless crime.” She said that about two-thirds of the women and men she has worked with suffered child abuse. About six in 10 needed health care services and three-quarters needed job training. About half contemplated or attempted suicide and a third were threatened with death.

“If you look at an emergency department, there is a constant coming and going of patients,” Reid said. “It’s easy to develop a tough skin and say, ‘That’s just another prostitute.’ But there is an underlying tragedy in every one of those lives.”

Among the attendees was Kari Waterman, MS, CNS, manager of clinical education at UCH. She said the presentation offered an important reminder that hospitals are not shielded from the problems of the streets.

“I think it brings a greater awareness of our societal issues that present to our hospital repeatedly,” Waterman said. “This presentation offered practical approaches to identifying and advocating for these victims when they present in our hospital.” She added that Reid also helped her to grasp the apparent paradox dubbed the “Stockholm syndrome,” which leads the abused to “feel a sense of trust for their abuser.”

Reid said those bonds of loyalty and unity can be difficult to break, but health care providers can help to do so. She noted that 28 percent of the victims she’s encountered have had contact with a provider during their captivity.

“There is no standard operating procedure for working with patients who might be victims of human trafficking,” Reid said. “But you might be the only person that that victim will talk to.”