Strangulation Forensic Examination

Abstract

Strangulation is one of the most dangerous forms of interpersonal violence (IVP), yet it is often not reported and missed by the health care provider because of lack of visible injury. The victim of strangulation can have critical injuries and a late onset symptoms. Victims of IVP should be directly asked whether they were choked or whether during the assault they felt like they could not breathe because of pressure on their neck. The objective of this article is to summarize "best practice" for health care providers so that they are better prepared to care for victims who report a history of strangulation. A summary of how to perform a forensic examination of the strangled patient is provided along with important documentation takeaways and useful forms to ensure that the severity of the strangulation is assessed, that critical injuries are identified, and that all injuries and findings are accurately documented for legal proceedings.

Injuries of Women Surviving Intimate Partner Strangulation and Subsequent Emergency Health Care Seeking: An Integrative Evidence Review

“…Best practice recommendations for clinicians are available. 13,25,26 Protocols for screening and assessment of strangulation in various care environments are emerging that can be helpful to diagnosis, care plans and referrals. Further development and testing, including leveraging information resources (e.g.…”

Improving Identification of Strangulation Injuries in Domestic Violence: Pilot Data From a Researcher–Practitioner Collaboration

“…The review of 300 known strangulation cases by Gael Strack, George McClane, and Dean Hawley revealed significant shortcomings in the way strangulation was identified, documented, and prosecuted (Hawley et al, 2001; McClane et al, 2001; Strack et al, 2001). This retrospective analysis of efforts by the San Diego City Attorney’s Office also serves as a model for how the justice system could easily and dramatically improve their response to strangulation (Strack et al, 2001); indeed, since this landmark study, many practical, legal, and academic inroads have been made (Douglas & Fitzgerald, 2014; Faugno, Waszak, Strack, Brooks, & Gwinn, 2013; Pritchard et al, 2016).…”

Nonfatal Strangulation as Part of Domestic Violence: A Review of Research

“…Other variable terms include ligature or ''garroting'' (e.g., Funk & Schuppel, 2003) or simply hanging. Others include ''choke hold'' to describe manual strangulation with a forearm instead of hands, or ''postural'' strangulation due to body position like an assailant compressing the chest of a victim (Faugno, Waszak, Strack, Brooks, & Gwinn, 2013). Some legal statutes (for instance, Rhode Island's 2012 law) also include descriptions of what is technically ''suffocation,'' or the prevention of breathing by covering the nose and/or mouth, within their statutory definition of strangulation (Verdi, 2013); indeed, suffocation may only vary slightly from strangulation if an attempted choke hold, for instance, results in an attacker placing a forearm across the face instead of the neck.…”

“…Many of these questions have begun to be investigated in clinical practice and research. Building on the initial clinical recommendations of McClane, Strack, and Hawley (2001), further recommendations on best practices for clinical evaluation and treatment have been developed (Faugno et al, 2013;Funk & Schuppel, 2003;Plattner et al, 2005), as well as an expansion of forensic and medical research into injury detection techniques for specific modalities or using specific diagnostic technologies like MRI (Christe et al, 2010;Clarot et al, 2005;Davison & Williams, 2012;Mitchell, Roach, Tyberg, Belenkie, & Sheldon, 2012;Yamasaki, Takase, Takada, & Nishi, 2009). In a clinical sample of 101 women presenting to a Dallas victim intervention center and emergency facilities, Smith and colleagues (2001) classified patients by the number of reported strangulation events, suggesting a cumulative ''dose-related'' effect of multiple strangulation events leading to presentation of more serious symptoms.…”

“…In a clinical sample of 101 women presenting to a Dallas victim intervention center and emergency facilities, Smith and colleagues (2001) classified patients by the number of reported strangulation events, suggesting a cumulative ''dose-related'' effect of multiple strangulation events leading to presentation of more serious symptoms. Notably, Plattner and colleagues (2005) have proposed a typology of strangulation injury severity, while both Funk and Schuppel (2003) and more recently Faugno, Waszak, Strack, Brooks, and Gwinn(2013) have created comprehensive reviews or guidelines for clinical practice.…”