The Investigation and Prosecution of Strangulation Cases Webinar Notes

Strangulation vs. Choking (02:00)

  • Choking is when an object gets in the airway internally.
  • Strangulation is when external pressure is applied to the neck obstructing airflow and blood flow.
  • Strangulation causes asphyxia.
    • Types of Stragulation
      • Manual
      • Ligature
      • Hanging


Statistics and Lethality Associated with Strangulation (04:21; 12:44)

  • 1 in 4 women experiences IPV, 10% of which is a strangulation assault.
  • 50% of victims have visible injuries of which only 15% can be photographed.
  • 99% suspects were men.
  • 50% has a history of domestic violence.
  • 43% of women murdered in domestic assaults are victims of attempted strangulation.
  • 45% of women who are victims of attempted murder were strangled in the past.
  • Women victims are 8x more likely to be killed by that partner.
  • Women victims are 7x more likely to survive an attempt on their life by an abusive partner at a later time.


Hurdles at Trial (08:03)

  • The Jury expects to see victims with very explicit strangulation marks.
  • Effects of strangulation don’t always show up immediately.


Arizona Statute 13-1204(B) on Aggravated Assault (13:20)

  • In the mid-90s, strangulation was just considered a misdemeanor but is now a class 4 felony in Arizona
  • A person commits aggravated assault if they:
    • Intentionally, knowingly or recklessly caused physical injury to another person.
    • Intentionally places another person in reasonable apprehension of imminent physical injury.
    • Knowingly touches another person with intent to injure the person.
    • And both occurs:
      • Defendant intentionally or knowingly impedes the normal breathing or circulation of blood by applying pressure to the throat, neck or obstructing the nose and mouth.
      • Defendant and victim are in a domestic relationship.


Signs of Strangulation (17:28)

  • Red face and/or neck
  • Petechiae (red pinpoint spots/burst blood vessel)
  • Bruising
  • Swollen tongue or lips
  • Bite marks inside mouth
  • Bruising in neck and under chin
  • Scratch marks
  • Fingernail impressions


Symptoms of Strangulation (22:53)

  • Difficulty breathing and or/hyperventilating
  • Raspy voice
  • Coughing
  • Hurts to swallow
  • Neck pain
  • Tenderness under the chin
  • Vomiting
  • Drooling
  • Dizzy
  • Headaches
  • Urination and/or defecation – biggest telltale sign


Anatomy of the Neck (27:12)

  • Jugular Vein
  • The outermost vein that brings deoxygenated blood from head to heart.
  • It akes about 4.4 lbs of pressure to cut off your jugular vein.
  • Carotid Vein
  • Supplies head and neck with oxygenated blood.
  • It takes about 11.1 lbs of pressure to cut off your carotid artery.
  • Trachea
  • The windpipe, where we breathe in and out.
  • It only takes about 3.3 lbs of pressure to impede the trachea


Tips on speaking with victims of Strangulation Assaults (32:09)

  • Get the initial narrative and details
    • Hand placement
    • The position victim’s body was in
    • Where was pressure felt?
    • Were you able to fight back?
    • How long was suspect holding your neck?
    • Did suspect say anything that can prove intent?
    • What do you remember happening right after suspect let go of your neck?
  • Get symptoms
    • How did your head/body feel during and immediately after the strangulation?
    • How do you feel now?
    • Anything else that I should know about?


Offer a Forensic Nurse Exam (35:58)

  • Obtain Medical History
  • Obtain Assault History
  • Obtain Vitals/Complete Medical Assessment
  • Head to Toe Exam
  • Document signs and symptoms
  • Photograph physical injury
  • Aftercare instructions
  • Recommend follow-up


What Victims of Non-Fatal Strangulation Need to Know (39:15)

  • Victims MUST see a doctor after the assault.
  • Responders, advocates, and victims must be aware of signs and report to Emergency if experiencing:
    • Difficulty in hearing
    • Changes in vision
    • Severe headache
    • Extreme drowsiness
    • Amnesia
    • Confusions
    • Trouble with balance
    • Difficulty speaking


Other Sources of Evidence (39:55)

  • The first person to come in contact with before police contact who:
    • saw the event or the victim running away from the event
    • whom the victim ran into
    • the victim stayed with,
    • saw signs of assault in the victim’s body
    • can identify the suspect
  • Establish if the victim didn’t previously have injuries?
  • Check for reports of disturbances or witnesses of the altercation.
  • Ask witnesses if they heard, saw or know something important.
  • Signs of struggle in the house/location (broken things, furniture, walls, etc.)
  • Victim’s appearance, condition, clothing
  • Suspect’s appearance


Proving Intent and Investigating a Self-Defense Claim (43:43)

  • Evidence of intent
    • Defendant’s words
    • Defendant’s actions
    • Length of strangulation
  • Investigating self-defense
    • Suspect’s injuries or lack of injuries
    • Pictures of the scene
    • Account of how is it self-defense
    • Size disparities of victim vs. suspect


Educate the Juror (46:31)

  • Strangulation is unique that doesn’t always leave visible injury, traces of blood, bruises or blunt force trauma.
  • And the neck is vulnerable, with important organs and parts running through it which can easily be broken and damaged.
  • Strangulation is dangerous rendering victim unconscious or dead within minutes.


Proving Strangulation (48:17)

  • Match evidence with element
  • What evidence (i.e., through signs, symptoms, emotions) do we need to prove impeded breathing or circulation of blood flow?


Q & A (50:19)

What questions do you wish 911 operators and dispatchers ask in such cases? (50:39)

How long could you not breathe?

Where did he apply the pressure?

Did he use his hand?

How do you feel right now?


Do you recommend that agency send fire and EMS aid immediately for anyone who reports they’ve been choked or strangled?

EMS and Fire are recommended to be sent immediately for symptoms and effects that don’t manifest immediately.


When a medical person such as forensic nurses are involved, do you have established protocols in place with them and can you describe those protocols? (53:25)

The victim must be seen within 5 days.

Law enforcement is not allowed in the room while the victim is being treated.


Why did the Arizona Statute stop short of calling strangulation of attempted murder? (55:38)

Depending on the case, or how long the strangulation occurred, and how the perpetrator acted towards the victim, there are cases where we would consider an attempted murder charge vs an aggravated assault charge.


Do you have some suggestions and ideas for follow-up for law enforcement officers in cases where there is domestic violence? (57:26)

Agencies do compliance checks to visit victims and if perpetrator released and is with the victim, will be separated from the victim to increase victim’s safety.


Do you have a device for advocates to connect with victims that are unwilling to do cooperate? (1:00:08)

                The advocate should get all information initially.

Let the prosecutor know to get detectives involved.


How do you handle the case when the strangulations are coming from children to other children? (1:02:33)

                Handled differently and a call that is made subjectively based on the circumstances.



“Sadly very few women take advantage of the opportunity to do follow up because they think that once they’re through this it’s over, I’m fine. The reality is there are long term effects from strangulation, and we wish more will take advantage of follow up because there’s a lot of danger that happens down the road from strangulation case.”


“Depending on the case, or how long the strangulation occurred, and how the perpetrator acted towards the victim, there are cases where we would consider an attempted murder charge vs an aggravated assault charge.”


“The neck is extremely vulnerable. When you feel your pulse, you’re feeling your jugular vein. There’s no muscle protecting it, no bones protecting it. It takes about 4.4 lbs of pressure to cut off your jugular vein. It only takes about 11.1 lbs of pressure to cut off your carotid artery and takes about 3.3 lbs of pressure to impede the trachea. It takes 22 lbs of pressure to open a can of soda.”


“Strangulation is really lethal and can lead to some long-term medical issues”


“It’s something you always want to be aware of, looking at the history of this offender, looking at what has been going on”






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