By Gael Strack, J.D.
California law now requires law enforcement to warn victims of the lethality of strangulation assaults and the need for immediate medical attention under Penal Code section 13701(I). Strangulation injuries are often internal with no external visible injuries making life- threatening injuries easy to miss without proper immediate assessment accurate diagnosis and treatment. A recent study revealed that 1 out of 47 strangled victim/patients experienced a carotid dissection. Damage to the carotid arteries can lead to a stroke and/or death. (Hawley, et al, 2001; Zuberi, et al, 2019; Leichtle, et al, 2010).
EMS responders play a critical role when responding to domestic violence calls, especially where the victim has been strangled. They can ask important questions to identify injuries that may be hidden by clothing or are internal and not visible. They can look for clues of strangulation when the victim can’t remember details or is too traumatized or afraid to speak. They will, of course, provide needed medical treatment and make appropriate transport decisions. Importantly, they can recognize and document physical findings relevant to the identification of non-fatal strangulation.
There are many reasons why injured victims decline medical attention: fear of retaliation, to protect her abuser, lack of child care, involvement by children protection services, work obligations, financial limitations, more concern for immediate safety than health, not wanting to disclose the abuse, not believing anyone can help and/or a perceived lack of time. In many cases, victims simply do not understand or under estimate the seriousness of non-fatal strangulation nor the need for medical care.
Our last webinar on EMS response was six years ago. Catch up on it here! In this session, we will review new medical materials that have emerged over the past six years and share some legal consideration every paramedic needs to know. The bulk of the presentation will be led by Dr. Worden. Dr. Worden is a medical advisor and faculty member for the Institute. He has made it his passion and mission to improve EMS’s response to non-fatal strangulation through education. He is also determined to improve protocol and practice not only in the state of Oklahoma but across the United States. Two states (Tennessee and Kentucky) are leading the way and now require EMS to receive domestic violence training.
Only two cities in America, Burleson and Kennedale, Texas, have passed city ordinances that require the development of strangulation task forces and protocols which includes sending EMS to respond to DV/Strangulation 911 calls. According to Ken Shetter, Mayor of Burleson, “the number of aggravated assaults increased dramatically in Burleson the first year after the ordinance was passed because cases were getting correctly charged because better evidence was developed on the scene and because the use of the checklist helped identify more cases of strangulation… victims were transported to the hospital by ambulance after on-scene evaluation by EMS in about 20% of the incidents.” Fortunately, many police agencies are now updating their domestic violence law enforcement protocols to include this best practice which is encouraged by the International Chiefs of Police.
Approximately 40-50% of all 911 calls are related to domestic violence. EMS responders are generally the first to arrive at the scene, either before, after or at the same time as law enforcement. They are usually the first to provide emergency medical services to victims with injuries. Sometimes the injuries are visible, but in strangulation cases those injuries are mainly internal and usually barely visible to the untrained eye. Since most victims of domestic violence tend to refuse transport for medical attention, one of our biggest challenges is treating strangulation as a medical emergency. We need to help victims understand why medical attention is necessary.
There are many reasons why injured victims decline medical attention: fear of retaliation, to protect her abuser, lack of child care, involvement by children protection services, work obligations, financial limitations, more concern for immediate safety than health, not wanting to disclose the abuse, not believing anyone can help and/or a perceived lack of time. In many cases, victims simply do not understand or under estimate the seriousness of non-fatal strangulation nor the need for medical care.
