The Maricopa County Attorney’s Office created a pilot project through the Chandler and Glendale police departments, training officers to look for and document scores of physical indicators of strangulation. Police take the victim to an emergency room or advocacy center, and a trained nurse gets to the victim within an hour.

Through a contract between the county and Scottsdale Healthcare, 26 trained nurses in Scottsdale Healthcare’s forensic-nurse-examiner unit perform a head-to-toe exam, document patients’ history and take swabs or samples that may be used in an investigation. The nurses are on call 24/7 and fill out a six-page medical report. All the evidence gathered by police and nurses can be used when the Maricopa County Attorney’s Office looks to file a felony strangulation case.

“We want to prevent this before this is a homicide. So, I really looked at this project as a domestic-violence homicide prevention,” said Cindi Nannetti, a major-crimes division chief in the County Attorney’s Office, who led the project. “Men who get to the point where they have their hands around someone, taking the life out of them, they’re the most dangerous. If you’re going to triage that population of (domestic violence) offenders, we need to target these people.”

The program began in December 2011. Since then, it has expanded Valley-wide. Fifteen police departments and the Maricopa County Sheriff’s Office have submitted strangulation cases to the County Attorney’s Office.

Nurses performed 720 exams on victims between December 2011 and July 5.

The result: The County Attorney’s Office’s filing rate of felony strangulation cases jumped to 56 percent from 14 percent.

The National Family Justice Center Alliance, which runs the training institute on strangulation prevention for the U.S. Department of Justice, promotes the program as a national model, helping train other jurisdictions.

“Strangulation assaults have been missed by law-enforcement agencies and prosecutors for almost 30 years because there were often few visible injuries. No one thought it was very serious,” said Casey Gwinn, the center’s director. “What’s happening in Phoenix right now is a clarion call for the country. If every community in America were to be doing what Maricopa County was doing, we would save hundreds and hundreds of women’s lives in domestic-violence assaults.”

The first sign of strangulation people think of might be a bruise or redness around the neck.

But there are other subtle signs — visible or not — that can help police strengthen a case against a suspect and increase chances of successful prosecution.

Those signs include bruises behind the ears, blood-red eyes, swollen tongue or neck, and petechiae, which are spots on the body that indicate internal ruptured blood vessels.

Officers also need to ask certain questions and know to look for signs that may be indicators of strangulation. For example, if a woman has a raspy voice, an officer should ask if her voice is normally raspy and take note of how long her voice stays raspy. If a woman has a fresh set of clothes by the time police arrive, the officer should ask if she changed after urinating or defecating when she was strangled to the point of unconsciousness.

“It’s not that this is rocket science, but if you don’t know what you’re looking for, how are you going to find it?” said Scottsdale police Sgt. Dan Rincon, who helped develop the program as well as the checklist of evidence and questions for police to follow.

Nurses in the program also are available throughout investigations of domestic-violence strangulation cases and are available to consult police or go to trial if they are needed. The nurses are trained to look for specific signs and minute details that may not be noted at an emergency room, said Karyn Rasile, forensic-nurse manager at Scottsdale Healthcare.

“You’ve now got this medical component by trained individuals,” Rasile said.

Victims are encouraged to contact their nurse if other symptoms show up in following days after their exam. The advocacy center helps victims connect with shelters or resources for protection, such as obtaining orders of protection or changing a lock.