Abstract
Background
Nonfatal strangulation has been identified as a common occurrence in intimate partner
violence and can be associated with significant injuries and, at times, increased
mortality.
Objective
This article describes a county interagency nonfatal strangulation initiative that
efficiently disseminated an educational program for police, emergency medical services,
emergency department staff, forensic nursing teams, and prosecuting attorneys, along
with a forensic nurse response program. Prior to initiation of this program, no educational
programs existed and no forensic examinations were being offered to victims of nonfatal
strangulation.
Methods
Early cooperation between agencies was crucial, particularly between the two major
health care systems in the county. A standardized forensic evaluation tool was developed,
along with nonfatal strangulation courses. Education of forensic nurses together with
prosecutors was unique and training of police, emergency medical services, and emergency
department staff was coordinated. Forensic nurses traveled to meet victims for standardized
examinations at 11 emergency departments. Creation of a secure Research Electronic
Data Capture database captured forensic examination information and a strangulation
task force provided means to assess the goals.
Results
This initiative educated > 80% of the county’s first responders and 79% of emergency
department staff within 3 months. During the first year of the program, 259 forensic
nurse examinations for nonfatal strangulation were recorded. Police reported a total
of 367 arrests for felony assault by strangulation.
Conclusions
Professionals providing legal and medical care to victims of nonfatal strangulation
can be educated and forensic nurse examinations can be implemented successfully in
an expeditious period of time with a county collaborative program approach.
Keywords
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References
- Frequency and relationship of reported symptomology in victims of intimate partner violence. The effects of multiple strangulation attacks.J Emerg Med. 2001; 21: 323-329
- Survey results of women who have been strangled while in an abusive relationship.J Emerg Med. 2001; 21: 297-302
- Differentiating among attempted, completed, and multiple nonfatal strangulation in women experiencing intimate partner violence.Womens Health Issues. 2018; 28: 104-111
- Intimate partner violence in same-sex relationships: an analysis of risk and rearrest.Crim Justice Behav. 2019; 46: 1515-1527
- A comparison of intimate partner violence strangulation between same-sex and different-sex couples.J Interpers Violence. 2021; 36: 2887-2905
- Nonfatal strangulation in sexual assault: a study of clinical assault characteristics highlighting the role of intimate partner violence.J Forensic Leg Med. 2016; 43: 1-7
Resource materials on strangulation. New York Correction History Society. Accessed November 30, 2011. http://www.correctionhistory.org/northcountry/html/knowlaw/strangulation3.htm
- A review of 300 attempted strangulation cases. Part I: criminal legal issues.J Emerg Med. 2001; 21: 303-309
- Obtaining justice for victims of strangulation in domestic violence: evidence based prosecution and strangulation-specific training.Inquiries. 2012; 4 (Accessed XXXX.)
- Non-fatal strangulation is an important risk factor for homicide of women.J Emerg Med. 2008; 35: 329-335
- Intimate partner homicide: review and implications of research and policy.Trauma Violence Abuse. 2007; 8: 246-269
- Strangulation injuries.WMJ. 2003; 102: 41-45
- Unexpected delayed death after manual strangulation: need for care examination in the emergency room.Monaldi Arch Chest Dis. 2009; 71: 132-134
- Review article: nonfatal strangulation: hidden injuries, hidden risks.Emerg Med Australas. 2019; 31: 302-308
- The effectiveness of a coordinated response toward nonfatal strangulation in facilitating evidence-based prosecution.Crim Justice Policy Rev. 2021; 32: 816-840
- Manual strangulation injuries of the larynx.Arch Otolaryngol Head Neck Surg. 1983; 109: 344-347
- Fatal and non-fatal bilateral delayed carotid artery dissection after manual strangulation.Forensic Sci Int. 2005; 149: 143-150
Domestic Violence Report 2014;19(6):81-100. Accessed May 19, 2022. https://www.civicresearchinstitute.com/pdfs/DVR1906.pdf
- Strangulation: a review of ligature, manual, and postural neck compression injuries.Ann Emerg Med. 1984; 13: 179-185
- Forensic assessment of survived strangulation.Forensic Sci Int. 2005; 153: 202-207
- Living victims of strangulation: a 10-year review of cases in a metropolitan community.Am J Forensic Med Pathol. 2010; 31: 320-325
- A review of 300 attempted strangulation cases. Part III: injuries in fatal cases.J Emerg Med. 2001; 21: 317-322
- Strangulation in intimate partner violence.in: Mitchell C Anglin D Intimate Partner Violence: A Health-Based Perspective. Oxford University Press, 2009: 217-236
- Strangulation Injuries.StatPearls, 2022
- Nonfatal strangulation as part of domestic violence: a review of research.Trauma Violence Abuse. 2015; 18: 407-424
- Prosecutorial response to nonfatal strangulation in domestic violence cases.Violence Vict. 2020; 35: 160-175
- "Do you know what it feels like to drown?" Strangulation as coercive control in intimate relationships.Psychol Women Q. 2014; 38: 124-137
- Review and analysis of laws related to strangulation in 50 states.Eval Rev. 2009; 33: 358-369
- Legal processes and gendered violence: cross applications for domestic violence protection orders.UNSW Law J. 2013; 36: 56-87
- Strangulation forensic examination: best practice for health care providers.Adv Emerg Nurs J. 2013; 35: 314-327
Non-Fatal Strangulation Documentation Toolkit. International Association of Forensic Nurses. Published November 2016. Accessed January 2019. www.ForensicNurses.org. https://cdn.ymaws.com/www.forensicnurses.org/resource/resmgr/resources/strangulation_documentation_.pdf
- Domestic violence documentation project 2012.J Forensic Leg Med. 2013; 20: 683-689
- Discounting women: doubting domestic violence survivors' credibility and dismissing their experiences.Univ PA Law Rev. 2019; 167: 399-461
- An introduction to implementation science for the non-specialist.BMC Psychol. 2015; 3: 1-12
- Nonfatal strangulation as part of domestic violence: a review of research.Trauma Violence Abuse. 2017; 18: 407-424
- Physical Injury from intimate partner violence: measurement strategies and challenges.J Obstet Gynecol Neonatal Nurs. 2008; 37: 228-233
- A multi-level analysis of community coordinating council.Am J Community Psych. 2005; 35: 49-63
- Sexual assault response teams (SARTs): an empirical review of their effectiveness and challenges to successful implementation.Trauma Violence Abuse. 2012; 14: 83-95
- Coordinated community response components for victims of intimate partner violence: a review of the literature.Aggress Violent Behav. 2014; 19: 363-371
Mecklenburg County Demographics. Accessed XXXX. https://www.mecknc.gov/HealthDepartment/HealthStatistics/Documents/Mecklenburg%20Demog%202018.pdf
- Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- REDCap Consortium. The REDCap Consortium: building an international community of software partners.J Biomed Inform. 2019; 95103208
- The Health Insurance Portability and Accountability Act of 1996. Pub L 104-191.Stat. 1936;
Article Info
Publication History
Published online: April 29, 2022
Accepted:
April 23,
2022
Received in revised form:
March 26,
2022
Received:
November 10,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
