DO NOT WRITE YOUR NAME ON THIS SURVEY

 

PLEASE PRINT LEGIBLY

 

Human Trafficking in the Emergency Department: A Survey

 

  1. Date ____________
  2. Institution (circle one):             Rhode Island Hospital                             The Miriam
  3. provider type (check one):      p attending    p EM resident                            

p physician assistant  p nurse practitioner   p registered nurse    

 p ÒmoonlighterÓ         p  Òtraveling nurseÓ  p other___________________

  1. years in this role (check one):  p  <1                            p 1-3                  p 4-5                p 6-10                                                                           p>10
  2. years working in the emergency dept (any ED; check one): 

p <1           p 1-3                 p 4-5                 p 6-10                              p >10

  1. Do you know what human trafficking is? (check one) pYes          p No
  2. Have you ever treated a victim of human trafficking in the E.D.? (Human trafficking is often referred to as Òmodern-day slavery,Ó or Òindentured servitude.Ó)

(check one) p Yes             p No (if no, skip to question #9)

  1. What did you do when the patient was identified as a potential trafficking victim? (check all that apply)

p called a hotline to report trafficking                          p called the police    

p called an intimate partner violence hotline                           p treated the emergent issue

p asked the potential victim about his/her safety    p no medical care was

    provided

p notified social work

 

p other ___________________________________________________________

9.   Have you ever been formally trained on the clinical presentation of trafficking

      victims? (check one) p Yes p No

       If yes, When? ________________  At what institution? ___________________

 

CONTINUE ON OTHER SIDE

 

  1. Have you ever been formally trained on the appropriate treatment of trafficking

victims? (check one)  p Yes p No

If yes, When? ________________  At what institution? ___________________

11. Would a workshop on the clinical presentation and treatment be useful to you in this E.D.? (check  one)         p Yes                p No                  p Unsure

12. Is human trafficking a problem that affects your patient population? (check one)

p Yes                        p No                  Unsure

  1. How confident are you in your ability to identify a human trafficking victim in the E.D.?

Very confidentÉÉÉÉ.ConfidentÉÉÉÉ..HesitantÉÉÉÉ....Not Confident

1                                          2                                          3                                          4

14. How confident are you in your ability to correctly treat a human trafficking victim in the E.D.?

Very confidentÉÉ..É..ConfidentÉÉ..ÉÉ..HesitantÉÉ.ÉÉ..Not Confident

1                                          2                                          3                                          4

 

THANK YOU FOR YOUR TIME