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Virtual Grand Rounds: What Physicians Need to Know

As a medical professional, you may encounter patients like “Tanika,” a nurse who was strangled by her husband in San Diego. Tanika presented to a California emergency department six days post strangulation at the urging of a San Diego Police Department domestic violence detective. Tanika reported that she had been placed in a “choke hold” and may have lost consciousness. What would you do if you saw Tanika?

She had no evidence of external neck trauma, had no difficulty swallowing, and was essentially asymptomatic as six days had passed from the strangulation. The detective had received training from the Institute on the unseen dangers of neck compression and the need for radiographic imaging of neck vessels post strangulation.

The emergency physician appropriately ordered a CTA. The radiologist soon notified the physician that Tanika had bilateral carotid dissections.She was anticoagulated for 9 months and survived without any morbidity. Had the emergency physician failed to order this life-saving CTA and discharged her home because she had no visible neck trauma and was asymptomatic, Tanika would have likely suffered a major stroke and may have died.

This 60-minute course is recommended to help doctors and medical professionals understand the incredible significance of handling cases where a victim has been strangled as well as how laws like EMTALA impact these cases. These cases are being mishandled in many places; this grand rounds will teach doctors what they need to know about treating these patients.

Attendees of our training learn: that doctors may not receive training on how to evaluate victims who say they have been choked; it is important to understand how to treat these patients and evaluate for internal injury; an overview on the physical mechanics of strangulation and structures of the neck.

Outcomes include: an increased awareness in victims presenting with strangulation; improved medical evaluation of strangulation.

Course Objectives:

  1. Increase awareness of the need for a CTA after strangulation
  2. Improve response to the strangled victim
  3. Improve knowledge of strangulation complications

Your Instructors:

Gael Strack is the Chief Executive Officer and Co-Founder of Alliance for HOPE International. The Alliance has five main programs: the National Family Justice Center, Training Institute on Strangulation Prevention, Camp HOPE America, VOICES and the Justice Legal Network. Gael is an internationally recognized expert in non-fatal strangulation cases and regularly trains on numerous topics. Gael is also an Adjunct Professor at California Western School of Law teaching a class on “Domestic Violence and the Law”.




Casey Gwinn – Casey Gwinn is the President and Co-Founder of the Alliance. He is the visionary behind the Family Justice Center Movement, first proposing the concept of the Family Justice Center model in 1989. Casey founded Camp HOPE America in 2003. He is a national expert on domestic violence dynamics, including investigation and prosecution, the handling of non-fatal strangulation cases, and is one of the leading thinkers in the country on the science of hope. Prior to this position, Casey was the elected San Diego City Attorney.




Bill Smock is the Police Surgeon and directs the Clinical Forensic Medicine Program for the Louisville Metro Police Department. He graduated from Centre College in Danville, Kentucky in 1981 and obtained a Master’s degree in Anatomy from the University of Louisville in 1987. Bill graduated from the University of Louisville, School of Medicine in 1990 and completed a residency in emergency medicine at the University of Louisville in 1993. In 1994, he became the first physician in the United States to complete a post-graduate fellowship in Clinical Forensic Medicine. Dr. Smock was an Assistant Medical Examiner with the Kentucky Medical Examiner’s Office from 1991 to 1997. Dr. Smock joined the faculty at University of Louisville’s Department of Emergency Medicine in 1994 and was promoted to the rank of full professor in 2005. Dr. Smock is currently a Clinical Professor of Emergency Medicine at the University of Louisville, School of Medicine and regularly takes medical students on mission trips to Africa.