Prosecutors implemented a program to collect more evidence in domestic-violence strangulation cases in 2012, and Maricopa County Attorney Bill Montgomery said more than 60 percent of domestic-violence cases involving strangulation have been prosecuted since the change.

Fewer than 15 percent of those types of cases resulted in charges being filed before the new protocol was implemented, Montgomery said at a news conference Wednesday morning.

Advocates are starting to recognize the impact of those changes and have started to address the needs that accompany that change in policy, he said, which can include a wide variety of items that range from equipment for forensic nurses to clothes and hygiene products for the victims whose belongings are collected as evidence.

Strangulation is a particularly dangerous form of domestic violence because a woman who is strangled is seven times more likely to become a victim of homicide, Montgomery said. Yet strangulation can be difficult to prosecute because there are frequently no witnesses to corroborate the victim’s account and evidence can be hard to gather.

Both Montgomery and anti-domestic-violence advocates said there is evidence to show that strangulation can be a precursor to more violent crimes, such as homicide.

“We have review teams that look for trends and markers leading up to an individual’s death,” said Jessye Johnson, chief operating officer for the Arizona Coalition to End Sexual and Domestic Violence. “Strangulation is one of those markers.”

The effects of strangulation can remain dormant for several days, which is why the forensic nurses encourage follow-up visits to further photograph and document injuries. Johnson also said that, if it goes untreated, strangulation can lead to swelling that could kill an individual several days after the incident.

Montgomery said the Maricopa County Attorney’s Office worked with Scottsdale Healthcare in the Strangulation Treatment and Offender Prosecution program to institute the use of high-resolution digital cameras by forensic nurses to better detect evidence of strangulation.

The trained nurses from Scottsdale Lincoln Health Network forensic unit perform a head-to-toe exam, document patient history and take swabs or samples that may be used in an investigation, said Tiffany Kirby, a forensic nurse. The nurses are on call 24/7 and fill out a six-page medical report for each victim of domestic violence, she said.

There are other units at various hospitals in the county, though the technology ranges for each unit, Kirby said.

All the evidence gathered by police and nurses can be used when the Maricopa County Attorney’s Office files a felony strangulation case, including the photographs they take of the victim, Kirby said.

The cameras each cost $20,000 to $25,000 and are capable of showing broken capillaries in the neck, behind the lips and around the eye, which are all signs of strangulation and lack of blood flow, Montgomery said.

Of all the cases to date reviewed since the program was launched, more than 38 percent have resulted in sentences ranging from three months in jail to prison terms of up to eight years, Montgomery said.

The program may also be reducing the number of domestic-violence-related fatalities in Arizona, Montgomery said. In 2012 there were 139 fatalities in all types of domestic violence cases, in 2013 there were 125 and in 2014 there were 106, Montgomery said.

The protocol set forth in Maricopa County is being recognized on a national level.

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 when training other jurisdictions, said Scottsdale police Sgt. Dan Rincon, a faculty member with the Justice Center Alliance.

Rincon said he originally created the police protocol following strangulation cases and pitched it to the County Attorney’s Office.

“The numbers are nothing short of phenomenal,” Rincon said. “We just have to keep it continuous and keep training officers to curate sustainability.”

The protocol was initially a pilot project for Chandler and Glendale police departments but is countywide, Rincon said, and other agencies around the country have started to create similar programs.

“I’m not sure if it is related to the strangulation project, but it does appear to be an instance of cause and effect,” Montgomery said. “It will take a few years to see how much of an effect the project is having.”

But the program comes with additional costs, including equipment, training and even new clothes for victims whose clothing is collected as evidence.

The Victim Next Door is a non-profit organization dedicated to helping the Scottsdale Healthcare forensic nurses in the health-care network unit collect donations to better sustain them, said Scottsdale Leadership class member Alice Giedraitis.

“It’s a direct way that people can help,” Giedraitis said. “The website, thevictimnextdoor.org, just launched last month and accepts all donations ranging from clothing to toothbrushes to money and it all goes to the forensic nurses unit.”