Strangulation Response
Per ARS § 13-1204.B1, Aggravated Assault by strangulation is a class four (4) felony and domestic violence offense. To obtain successful prosecution of this crime, a multi-disciplinary response is recommended.
A. Responding detectives and/or officers will investigate if there is evidence of the following:
1. A domestic violence relationship, as defined in ARS § 13-3601, between the suspect and victim.
2. The victim’s normal breathing and/or circulation was intentionally or
knowingly impeded by pressure having been applied to the throat or neck of the victim or by obstruction of the victim’s nose and mouth either manually or
through the use of an instrument;.
a. Victim reports their neck/throat was “choked” or “strangled” by hands, arms, legs or object, such as a ligature.
b. Victim reports suffocation; manually or with a device that was used to cover the victim’s nose/mouth to impede breathing.
c. The victim expresses or displays at least one of the signs and/or symptoms of strangulation1: Signs and symptoms include but are not limited to:
• Loss of Consciousness, fainting; • Memory loss and/or confusion; • Loss of control of bladder or bowels; • Confusion/loss of sense of time; • Lightheaded or dizziness;
• Nausea, coughing or vomiting;
• Voice changes (raspy, whisper, hoarse); • Difficulty breathing and/or swallowing; • Pain with swallowing;
• Redness, bruising (contusions), scratches (abrasions), swelling, pain to the neck; or
• Petechiae (very small red dots) at and/or above the point of constriction. • Vision changes
• Fingertip bruising
• Blood red eyes (due to capillary rupture in the white part of the eyes).
1
First responding officers should be aware that many times injuries exist but may not visible at the time of law enforcement’s initial response.
**The victim may be unable to verbalize symptoms of strangulation due to confusion or stress at the time of the call. Law enforcement should ask the victim if s/he experienced any of the listed
symptoms and document positive responses.
B. If law enforcement observes or receives evidence of the criteria in paragraph A; the following investigative procedures should be followed:
1. The responding law enforcement officer will assess if emergency medical response is warranted.
2. The victim should be asked by the responding law enforcement officer if s/he is willing to voluntarily participate in a medical-forensic examination at no cost to the victim
3. If the victim agrees to participate in the medical-forensic examination,
transportation to an advocacy center or hospital (if medically indicated) shall be arranged.
4. The responding law enforcement officer should consider notifying a law enforcement victim advocate.
5. All interviews with the victim, suspect and witnesses should be audio and/or video recorded, if possible.
6. The condition of the scene, victim and suspect upon arrival shall be documented.
7. All statements by the victim, suspect, or witnesses shall be documented. 8. All evidence from the scene shall be photographed and collected; including,
but not limited to:
a. Ligatures, including such as items jewelry, cords, or ropes,. b. Other devices that may have been used to smother the victim,
including such as items pillows, linens, or clothing.
9. As all other domestic violence response protocols and policies set by your agency shall be followed.
C. Forensic Nurses’ Role
1. A forensic nurse is requested to respond to the victim’s location, which could be one of the following:
a. An advocacy center b. A hospital
• If the victim was transported to a hospital, the medical forensic exam can be performed there if the victim is not medically cleared to be discharged.
• If the victim is transported to a hospital for evaluation, but not admitted, the exam will be performed at an advocacy center after the victim is discharged.
c. A jail or prison medical unit
2. The forensic nurse performs the medical-forensic examination, which includes:
a. Obtaining a patient history.
b. Conducting a head to toe examination.
o Written and photographic documentation of all injuries
c. Providing aftercare instructions, including but not limited to safety plan, strangulation warnings.
3. The forensic nurse shall provide law enforcement with a Domestic Violence kit, including written report and CD of jpeg photos, generally within two hours of completion of the exam
4. The original chart along with RAW and jpeg photos will be maintained by forensic nurse examiners. The chart and materials will be available for the DCA to review if needed.
D. Follow up with the victim after exam/submittal/arrest
1. The forensic nurse will recommend follow-up photographs and
appointments as part of the overall exam. These will be conducted at the Scottsdale Family Advocacy Center by appointment during normal business hours.
2. While not required, law enforcement should consider providing the victim with transportation to the follow-up appointment. This is an opportunity for law enforcement to further interact with the victim and develop a rapport.
3. If the victim is unable or unwilling to participate in a follow up appointment, consider taking a second set of photographs at the victim’s location.
4. Consider use of law enforcement victim advocates to respond to centers to allow victims early access to services.
E. Training/Resources
1. MCAO will provide a 7-10 minute strangulation training video for all first time responders.
2. The Scottsdale Lincoln Healthcare Network SLHN Forensic Nurse Examiners are available to speak to all first responders (law
enforcement and fire), prosecutors, advocates about the lethality of strangulation and the presentation of strangulation victims.
3. All first responders should be trained on basic strangulation and lethality.
4. All sergeants and detectives should keep current on in-depth strangulation training to assess lethality issues.
5. Some of the available training resources include:
• Strangulation webinar by Aequitas at
http://www.aequitasresource.org/trainingDetail.cfm?id=50
• Training Institute on Strangling Prevention at