Having recently testified in several legal cases involving strangulation, here are some facts we all need to know about this extreme form of domestic violence (DV). I invite other subject matter experts to share their personal opinions on what is important.

1. Strangulation is assault with a deadly weapon – an act with known potential lethal consequences. Formally defined, strangulation is an external force applied to the neck cutting off blood supply to the brain and/or air intake to the body, frequently done for dominance and control. Criminal strangulation begins when external force applied to the neck causes a change in the body’s physiology.

2. Strangulation should be considered one of the most serious forms of domestic violence because the victim is only seconds away from death at any time.

3. Strangulation is different from choking; choking is defined as a blockage of the airway by a physical object such as a hot dog.

4. There are two main forms of strangulation: manual and ligature: the manual form involves hands, arms, or other body parts, while ligature means the use of a cord, rope, bed sheet, or similar accessory. Hanging is a variant of ligature strangulation.

5. 99 percent of the domestic violence cases involving strangulation are a male strangling a female; same-sex strangulation is less often fatal than hetero DV.

6. Loss of consciousness occurs, on average, in 6.8 seconds of continuous pressure on the carotid arteries.

7. Death can occur in as early as 62 seconds (judicial hangings or executions have a different mechanism of injury and timetable). As little as eleven pounds of pressure to the carotid arteries, applied for 62 to 157 seconds will result in death.

8. Serious injuries, including carotid dissections and fractures, and death can occur with little or no physical external evidence of trauma.

9. A CTA of the neck is the test of choice to rule out the presence of internal injuries, including carotid and vertebral artery dissections.

10. Victims surviving strangulation frequently suffer lifelong physical and psychological trauma and are 7.5 times more likely to be a victim of domestic homicide at the hands of the same strangler.

Dan Field is an emergency physician.

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