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Strangulation has only recently been identified as one of the most lethal forms of domestic violence: unconsciousness may occur within seconds and death within minutes. When domestic violence perpetrators choke (strangle) their victims, not only is this a felonious assault, but it may be an attempted homicide. Strangulation is an ultimate form of power and control, where the batterer can demonstrate control over the victim’s next breath, having devastating psychological effects or a potentially fatal outcome.

It can be difficult to document and prosecute strangulation cases despite their lethality because injuries may appear to be minor or non-existent. However, medical research has shown this is far from the case—victims of strangulation can experience lasting medical and psychological consequences. Proper training of police officers, prosecutors, and medical professionals is vital to improving the prosecution of these offenders in felony or attempted murder strangulation cases.

Course Objectives:

  1. Increased awareness of the seriousness of strangulation assaults
  2. Increase understanding of the signs and symptoms of strangulation
  3. Improved understanding of the documentation of evidence and follow up investigations
  4. Improved understanding of advocacy for victims


Training Length:  2 hours


Course Directors:

Gael Strack – 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.


Course Outline:


Welcome and Introduction (3 minutes)


Lesson 1: Strangulation 101 (3 minutes)

  1. Definition of Strangulation
  2. Choke vs Strangle
  3. Manual Strangulation vs Ligature Strangulation

Lesson 2: Anatomy (3 minutes)

  1. Anatomy of Manual Strangulation

Lesson 3:  Signs and Symptoms (10 minutes)

  1. First Clues to Look For
  2. Signs vs Symptoms
  3. What to Ask the Victim

Lesson 4: Petechiae (5 minutes)

  1. Why Petechiae Occur
  2. Where to Look for Petechiae

Lesson 5: Unconsciousness and Death (6 minutes)

  1. Phases of Strangulation Assaults
  2. Lethality of Strangulation

Lesson 6: Suffocation (2 minutes)

  1. Definition and Methods of Suffocation
  2. State Statutes on Suffocation and Strangulation

Lesson 7: First Response (8 minutes)

  1. Questions to Ask the Victim
  2. Why Officers Might Downplay the Situation
  3. What to Look For in the Crime Scene
  4. Discussing Signs, Symptoms, and Medical Treatment with Survivors

Lesson 8: Identification of the Primary Aggressor (3 minutes)

  1. Visible Injuries on the Aggressor and Lack of Injuries on Victim
  2. How to Identify Self Defense Mechanisms

Lesson 9: Medical/Forensic Documentation (8 minutes)

  1. What to Document
  2. Body Diagraming and Charting
  3. Medical Examinations

Lesson 10: Follow Up Investigation and Care (4 minutes)

  1. Importance of Follow Up Investigation
  2. What is Often Missed in an Investigation

Lesson 11: Prosecution (2 minutes)

  1. Why Prosecutors Need to Care

Lesson 12: Defense Theories (6 minutes)

  1. Self Infliction and Self Defense
  2. Unintentional Sex Injury and Auto-Erotic Sexual Asphyxia
  3. Victim Stages Own Murder to Accuse Partner
  4. Choking Game

Lesson 13: Using Experts (6 minutes)

  1. How to Educate the Jury
  2. Importance of Strangulation Training
  3. Tips for Testifying as an Expert

Lesson 14: Understanding the Lethality (10 minutes)

  1. How to Explain  Seriousness of  the Crime to the Victim
  2. Power and Control of Strangulation
  3. Safety Planning and Tools to Assess Danger

Lesson 15: Role of Advocates (3 minutes)

  1. Supporting Survivors
  2. Educating Prosecutors

Lesson 16: The Link to Sexual Assault (2 minutes)

  1. Close Connection Between Sexual Assault and Strangulation

Lesson 17: Treatment, PTSD, & Long Term Consequences (9 minutes)

  1. Understanding Survivor Symptoms
  2. The Multidisciplinary Approach to Helping Survivors

Lesson 18: Education, Training, & Implementation (10 minutes)

  1. Importance of Education for professionals AND Victims
  2. Making Training Relatable
  3. Multidisciplinary Approach to Training

Lesson 19: Community Response and Conclusion (8 minutes)

  1. Significance of Co-Located Services
  2. Ending the Cycle of Violence

Course Content