Most victims of strangulation will not have visible external injuries
Non-fatal strangulations point to future homicides.
Choking is an internal blocking of the airway by an object. In contrast, strangulation is a form of asphyxiation characterized by closure or restriction of the airway or vessels in the neck by external pressure. The key words to focus on are “external” and “neck.” The closure of a single structure of the neck that supplies oxygen to the brain is all that is required to kill a person.
An idea was promulgated for decades that there must be external signs of injury such as marks on the neck and/or petechial hemorrhage in the eyes when strangulation occurred. It was believed that without those injuries the assault could not be proven and likely did not occur. This idea is far from the truth. Gael Strack, former prosecutor and chief executive of the Institute on Strangulation Prevention states, “Our study proves it—most victims of strangulation will not have visible external injuries. Lack of injuries and lack of training caused the criminal justice system to minimize strangulation.”
Injuries from strangulation can be delayed so that victims may not exhibit any signs immediately after the assault, however, they may exhibit signs hours or days later. Take for example an athlete that sprains their ankle, but can finish the game only to wake up the next day with an ankle so swollen and injured that it cannot be walked on. This can be observed in some strangulation victims who can talk and breathe normally one minute and be near death in the hospital the next. Research on strangulation in the medical field and in case studies now clearly shows that injuries can also be immediate, they will likely be permanent and they are absolutely life threatening.
It can take as little as five pounds of pressure for six to ten seconds to render a person unconscious. This is less pressure than opening a can of soda or pulling the trigger on most law enforcement pistols. One can understand why there may be no external signs or injuries on the victim when considering how little pressure is needed to render them unconscious. Signs and symptoms known to be associated with strangulation now include a raspy or hoarse voice, difficulty breathing, vision changes, fluid in the lungs, vomiting and involuntary loss of bladder/bowel control.
Look to the signs
Although many organs in the body may be affected, it is the brain that is most affected by lack of oxygen. If a person loses consciousness because the brain has been starved of oxygen then there is permanent brain damage. Loss of consciousness also means lack of memory since the hippocampus—the part of the brain that stores memory—is most affected by lack of oxygen. All too often the lack of detail from victims is associated with lack of credibility. With regard to strangulation, however, lack of detail and memory points directly to an indicator there was loss of consciousness. Proper trauma-informed interviewing of a victim is key when there is loss of consciousness.
In instances where there is no loss of consciousness, it is possible that arteries/veins in the neck can tear internally, causing blood clots. These clots left alone and without immediate medical treatment can lead to stroke and death even weeks later. Brain death can occur within two minutes or less when the brain is deprived of oxygen. Delayed death can occur hours, weeks or months later due to internal injuries as mentioned previously. Unfortunately, victims only seek medical attention about three percent of the time. Therefore, it is important for law enforcement to take the lead on getting victims medical help as soon as possible.
In reality, the act of strangulation itself is a lethal act regardless of an offender’s intent. It tells us that the offender has a propensity to use lethal violence and I would argue also demonstrates a mindset that lethal violence is justifiable against anyone. If an offender is willing to harm their intimate partner, child, vulnerable adult or anyone using strangulation, then they can kill anyone. Many studies have shown this to be true. A study of 300 “choking” cases by the Family Justice Center Alliance in San Diego and Institute on Strangulation Prevention showed that a woman who is strangled even once is 750 percent more likely to be strangled again and 800 percent more likely to be killed later. Domestic violence victims often suffer repeated strangulations because law enforcement has not been informed of the subtle signs or the victim has delayed reporting to law enforcement.
A study by the same group on risks to law enforcement showed that 80 percent of critical incidents where officers were shot or had to shoot an attacker involved offenders with a history of domestic violence. Many of these offenders also had a background of strangulation assaults. As if the dangers to officers were not enough, the general public is now at increased risk. Research is showing that many of the domestic mass shooters in the U.S. also had a history of domestic violence and strangulation prior to their mass killings.
Church shooter Devin Kelley killed 26 people in Sutherland Springs, Texas. He had a known history of strangling his wife and fracturing his stepson’s skull, but the authorities in that case filed charges as misdemeanors.
Esteban Santiago killed five in a Fort Lauderdale, Florida airport and his past history was that of strangling his girlfriend in Alaska. He, however, was allowed to sign a sentencing agreement to have his charges reduced, which ultimately allowed him to own and transport a gun into the airport.
Omar Mateen killed 49 at the Orlando Pulse night club. It is reported he had strangled two of his past wives but was never charged or prosecuted.
As Casey Gwinn, cofounder of the Institute for Strangulation Prevention states, “Men who strangle women might as well be raising their hand and saying I am a killer.” Gwinn also refers to strangulation as a “warning shot” that gives every indication that lethal violence is sure to follow.
Tools to aid investigation
Though domestic violence and/or intimate partner violence are the crimes most often associated with strangulation, it goes far beyond intimate partner violence and must be extended to other crimes and victim types. Strangulation assaults are seen in abuse of vulnerable adults, child abuse, sexual assault, kidnappings and even robberies.
There are tools available to help raise the level of awareness and to increase the frequency of charges and successful prosecution for non-fatal strangulation assaults:
First: The Training Institute for Strangulation Prevention provides many online training courses and webinars free of charge. A good entry level course is a 25 minute fully interactive video on strangulation. It can be taken by going to the Institute’s website at www.strangulationtraininginstitute.com and looking under the training tab. Officers may also look under the resources tab to print investigative checklists, signs/symptoms information sheets, pamphlets for victims and investigation manuals. I’d like to emphasize the use of the investigative checklists as these can help prove a non-fatal strangulation case when there is little physical evidence of external injury.
Second: We all know that photo documentation of any assault is extremely important because it can speak for the unwilling or unavailable victim. It can be very difficult to document injuries with pictures when little to no external signs of strangulation are present on a victim. Research has shown that of observable strangulation injuries less than 15 percent are actually able to be photographed.
When taking photographs, make sure you use an approved camera or imaging device. It is generally not a good practice to use a cellphone to take pictures since a discovery motion by a defense attorney may require it to be turned over for full examination of its contents. Also, have adequate lighting to show the injuries you are trying to document. Using a flash is not always appropriate and in other instances a flash has to be used. Camera flashes are often offset from the lens and at times can create shadows that distort what we need to see. Perhaps a better option is to use what is called a “ring flash” that surrounds the camera lens to provide even light. This can enhance pictures of injuries taken at very close distances. Companies such as Secure Digital Forensic Imaging (SDFI) have special cameras that include a ring flash and proprietary software that can enhance hard to see injuries. These images can often be admitted as evidence in court because of SDFI’s chain of custody and secure storage software. There is an interest in using thermal imaging for assault investigations, too. A new camera to note is made by Thermal Expert and can be attached to mobile devices and tables. Initial examination shows it tends to offer better resolution and more diversity in image capture than similar products. Research to validate thermal imaging is still being conducted; therefore, officers should consult with their legal staff prior to utilizing such devices for evidence collection.
We must raise awareness of non-fatal strangulations and recognize that this knowledge benefits not just the crime victim but the public and law enforcement as well. The victims we respond to, the citizens we protect and even the fellow officers we serve with are all at risk if we fail to recognize that non-fatal strangulation is a sign of future lethal violence.
A Cry For Justice thanks Brian Bennett, the author of this article, for pointing us to and giving us permission to repost his article. His original article is Subtle Signs Of A Killer. ACFJ removed the first two paragraphs in this reblog and we retitled the article because most of our readers are victims of abuse, not law-enforcement officers.
Brian Bennett has 20 years of law enforcement experience and serves as an instructor at the South Carolina Criminal Justice Academy. His is skilled in various law enforcement disciplines and is court qualified as an expert in police training. Areas of expertise include domestic violence, vulnerable adult victimization and strangulation. He can be reached at Bkbennett@sccja.sc.gov.
For further reading: Have you been strangled? Or smothered so you couldn’t breath?