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|Focus on Manual
Ellen Taliaferro, MD, FACEP
Prior to ten years ago, few health care
and legal professionals had little awareness of the
presence and seriousness of strangulation as a form of
domestic violence assault. Indeed, the first
hint that manual strangulation injuries might
be more common than realized appeared in the medical
literature in 1985.
a landmark series of six articles addressing
strangulation as a form of domestic violence assault
appeared in the October issue of the Journal of Emergency
Medicine. Since then, much has happened as more and more
legal and health professionals have been trained in how
to recognize and document strangulation assault and in
how to care for victims of strangulation.
strangulation accounts for 97% of all domestic
violence strangulation attacks
- Of women who present to a busy emergency department for
treatment of a domestic violence physical assault, 23% of
them have been strangled
- 50% of women who are examined within a few hours of
being strangled have
no signs of strangulation
- Strangulation assault is a life-threatening event that
takes a major toll on the lives of many of the survivors of
- Women who have been strangled within the past 24 hours
should be admitted or observed in the hospital
This issue of the Health After Trauma eZine is dedicated to
the topic of strangulation as a form of DV/IPV assault.
|We Used to Call It Choking
Gael B. Strack, JD
CEO & Co-Founder,
Family Justice Center Alliance
two teenagers died as a result of domestic violence:
Casondra Steward (17) and Tamara Smith (16). Both
teenagers were also young mothers. Both had a history of
domestic violence and had previously been choked before
their deaths. The deaths of these two teenagers were
shocking and a sobering reminder of the reality of teen
relationship violence. The abrupt deaths also led to an
informal death review, a study of existing strangulation
cases being prosecuted within the San Diego City
Attorney's Office and specialized training for domestic
Fourteen years later, our effort to not
let Casondra and Tamara die in vain has grown stronger.
Working with professionals from around the country,
26 states have passed felony strangulation
statutes. Minnesota even studied the impact
of its new law. There are numerous published articles,
training videos, sample questions for experts to use in
court, brochures for police officers, specialized forms,
journals for victims to log their signs and symptoms,
improved advocacy and safety planning, and much
education and awareness, we have gone from calling it a
"choking" or "just a misdemeanor" to recognizing in most
domestic violence situations we are dealing with a
serious, felonious strangulation case. We recognize now
that strangulation is serious and one of the most lethal
forms of domestic violence: unconsciousness may occur
within seconds and death within minutes. Victims may have
no visible injuries whatsoever. Yet because of underlying
brain damage by lack of oxygen during the strangling,
victims may have serious internal injuries or die days or
several weeks later. Strangulation may also cause victims
to have ...
|Expert Witnesses Needed for Prosecution of
Strangulation Attack as a Felony
Many states have now deemed a
strangulation assault to be a felony. However, jury
members often do not understand the seriousness of
strangulation. A medical expert witness will help explain
strangulation as serious assault
If you are a health care provider preparing to serve as an
expert witness for a strangulation case or a prosecutor
preparing for trial, these "Questions for Strangulation
Experts" developed by Dr. George McClane, Dr. Dean Hawley, and
attorney Gael Strack will be a very useful tool for you.
Lethal Form of Interpersonal Violence
Ruth I Downing
MSN RN CNP SANE-A
or "choking" has recently become known as a form of
interpersonal violence causing serious injury. Patients
presenting with no external evidence of trauma can have
life-threatening internal injuries as a result of blunt
force injury to neck tissues. Recent research describes
this form of violence as serious and worthy of higher
consideration from health care and legal professionals.
Some states have passed laws making nonfatal
strangulation a felony offense.
It is important to distinguish...
Story: From Misdemeanor to Felony Charges
RN, MS Training and Education Director, Domestic Violence
I feel extremely fortunate and very
grateful to be alive after years of abuse. Over a
thirty-year span of time, I've had a unique opportunity
as a survivor and as a nurse to take part in the growth
process as we care for victims of violence. I've learned
to embrace the fact that as we continue moving forward,
we must never forget where we've been.
Thirty years ago, the overall response to
domestic violence and sexual assault was less than
favorable. Advocacy was in its infancy. Victims were
often questioned as if they had caused the violence.
Domestic violence was considered ...
|Thyroid Storm Induced by
Thyrotoxicosis crisis (thyroid storm) occurs when increased
circulating thyroid hormones provoke life-threatening
dysfunction of multiple organs. This life-threatening
condition has now been reported to occur after a
strangulation event in a 37 year-old woman.
Jesús I. Ramírez, MD; Patrizio Petrone, MD; Eric J.
Kuncir, MD, FACS; Juan A. Asensio, MD, FACS reported such
a case in a 2004 issue of the Southern Medical
To get the article online, click below and then register as
a new user of the journal's website
9th Annual Justice and Hope Domestic Violence
Join us for the 9th annual Justice and Hope Domestic
Violence conference on Thursday, March 12, 2009 at the
Cowlitz Expo Center in Longview, Washington. Keynote
speaker: Dr. Donald Smith, Jr., Child Trauma fellow and
co-founder, President, and Executive Director for
Generations Center, a non-profit center in Dallas, TX, for
the prevention of youth and family violence.
Workshops will include: Impact on Children and Teens
Witnessing Violence, Compassion Fatigue, The Healing Power
of Humor for People Helpers, In Her Shoes-Why She Stays,
and Challenges of DV Intervention in Rural Communities.
Cost for coffee, snacks, lunch and materials: $100. For
more information, call conference coordinator, Chere Weiss
at (360) 414-7533 or email: CWeiss@peacehealth.org
Do you have a conference that you want featured in
If so, let Dr T know about your upcoming event by clicking here.
For additional exposure for your event, sign up for a free
membership to the Saving Cinderella network and post your event
on that website as well.
Best friends are where you find
Warning: This little video will put a small smile in your
heart. If you are trying to work up a good mad about something,
best to watch later.
first day of medical school, our anatomy professor
that in medicine the questions
were always the same. "It is only
the answers that change," he
admonished us. We all laughed.
Surely he was telling a joke.
Not so. He spoke the truth. The
answers always change.
Yesterday's answers change as
new research emerges.
the answers change, other
change is called for. Here are two major changes coming
Health After Trauma Project:
- Future eZines will be
intermittent and focused on specific topics
- A major overhaul of our
Health After Trauma
website is in the works--we look forward to making the
announcement when the
"new look" is firmly in place
To further our learning and
understanding of manual
strangulation as a form of DV/IPV
assault, the Health After Trauma
website will add a resource center dedicated to the issue
of manual strangulation.
From Our Bookstore
From the Medical Directions, Inc Bookstore
Family Justice Center Books