Know the Law: Detecting &
 Investigating Strangulation

A Special Note to Dispatchers or 911 Operators


Injuries often appear to be mild, but internal damages which are not visible may progress to a fatal outcome, and for documentation purposes, the victim should be encouraged to seek medical treatment or a paramedic should be called. This is especially true when the victim has a raspy voice or sounds literally "out of breath."

Often, these sounds are indicative of a narrowing of the air tube, (Stridor) and will be taken very seriously in the Emergency Room.

Operators may ask if it is difficult or painful to swallow or to breathe. Also ask if there is a change in the voice. Furthermore, it is imperative that the tape recordings of the telephone conversations be preserved.

Remember over 50% of victims experience changes in their voice, which might be indicated on the tape. Additionally, hearsay statements on the tape may be admissible in court.

Some prosecutors will play the 911 tape to remind a victim who is reluctant to testify of the fear and other emotions she experienced at the time of the assault. This reminder will sometimes get her to testify.

The Medical/Forensic Examination Checklist

 Serial neuro check

Check for other injuries and cause

Check for Stridor injuries and cause

C-spine clearance and precautions

Inspect neck, face, eyelids, mouth, head, shoulder, chest, and chin

Rape examination


Medical Documentation

Pulse oximetry

X-Ray of soft tissue

MRI of the neck

CT scan of the neck

Bilateral Carotid Doppler


Fiberoptic laryngo


Petechial hemorrhages

Laryngeal mucosal edema

DNA typing of epithelial cells


Medical Treatment.

Airway surveillance.

Neuro assessment.

Suicide precautions


Follow-up Questions
for Strangulation Cases

By: Dr. George McClane, Emergency Physician &
Gael B. Strack, San Diego Assistant District Attorney

  1. Ask the victim to describe how she was strangled? Describe method.            One or two hands? Forearm? Object?

  2.         What did the suspect say while he was strangling the victim?

  3.         Was the victim shaken simultaneously while being strangled?            Describe.

  4.         Was the victim thrown against wall, floor or ground? Describe facts & surface.

  5.         How long did the defendant strangle the victim?

  6.         How many times was the victim strangled? Describe each incident & method.

  7.         How much pressure was used? Describe. Was it continuous?

  8.         Any difficulty breathing?

  9.         Any complaint of a hoarse or raspy voice?

  10.       Any complaint of pain to throat?

  11.       Any coughing or trouble swallowing?

  12.       How did the victim feel? (e.g. dizzy, faint or lose consciousness?)

  13.       Did the victim vomit, urinate or defecate as a result of being strangled?

  14.       Look for injuries behind the ears, all around the neck, chin, jaw, eyelids, shoulders and chest area. Take photographs of any visible injury however minor and describe injuries.

  15.       After photos are taken of the victim's injuries, ask victim to demonstrate how she was strangled. Document pain, points of contact and method of strangulation.

  16.       Ask victim to describe suspect's demeanor and facial expressions.

  17.       What did the victim think was going to happen? (e.g. Did she think she was going to die?)

  18.       If an object was used to strangle the victim, describe, photograph and impound object as evidence.

  19.       Was the suspect wearing any rings? Look for marks caused by rings.

  20.       Any prior incidents of strangulation? Or any pre-existing injuries?

  21.       Did the victim try to protect herself or himself? Describe.

  22.       Encourage medical treatment.

  23.       During follow-up investigation, take follow-up photos of any subsequent injuries. Ask if she showed injuries to anyone, took any subsequent photographs or sought medical attention?

           In 70 to 80 percent of all domestic violence cases, the victim will recant. Therefore law enforcement should anticipate this and plan on prosecution based on the evidence, just like in a murder case. Efforts should be made to investigate the cases like an attempted homicide case. It is important to ask as many questions as possible at the earliest time possible. The questions on the previous page are strongly encouraged.

           Prosecutors, be sure to write the officers a commendation letter if the report contains the answers to the above questions.

           San Diego trained their law enforcement officers, dispatchers, medical personnel and prosecutors. Immediately thereafter prosecutions
and convictions increased dramatically.


Condensed by Caran Curry, 
NYPTI CLE Coordinator



Furnished by ADA Gael Strack


STATEMENT OF MARIA                                                                    (VICTIM / REPORTING PARTY)


At about 1900 hours, Maria met (name of accused [NOA]) who was driving her van. Maria got into the van and NOA drove to Dominion Avenue and "T" St. Maria asked NOA to give her van back. NOA got upset and grabbed her by the throat. Maria said NOA squeezed her throat and neck area causing her to gasp for air. Maria said NOA put one hand over her mouth. Maria said she started crying. She said NOA started pulling her hair, telling her to get out of the van. Maria said NOA told her "I don't care if I go to jail, you are going to die." Maria said NOA then drove her to 4563 Logan Avenue. She said NOA then took her keys to her apartment. Maria said she went to a friendís house and got her spare keys. She said she came back to her apartment at 4563 Logan Avenue and called the police.


I saw red marks on Maria's neck, which she said were caused when NOA strangled her. Based on Officer training and experience, I know that strangling a victim can cause serious bodily injuries. I have attended a domestic violence class taught by Gael Strack. During the class, I saw a video by Dr. George McClane of Scripps Memorial Hospital. Doctor McClane stated that only eleven pounds of pressure for ten seconds could cause a strangulation victim to go unconscious. This pressure is enough to do serious bodily injury.

INJURIES:                                                                        PROPERTY DAMAGE:

Maria had red marks on her neck area                                  None


EVIDENCE:                                                                      RELATED REPORTS:

Three photos of injuries were                                                None

taken by _____________ # ______________ and attached to the report.