The following publications are for intimate partner violence professionals working with victims of strangulation. Please note that not all of the publications listed below are free for public use; some require a payment to view the full article.

2017 San Diego County Strangulation Protocol

The San Diego County Strangulation Protocol is adopted to increase public safety, promote public health, and to ultimately save lives. By improving the detection and documentation of domestic violence strangulation cases, San Diego County can better assist victims and hold offenders accountable for these serious criminal acts.

An Overview of Strangulation Injuries and Nursing Implications

The purpose of this topic brief is to provide the emergency nurse with an overview of strangulation injuries and clinically relevant information to enhance assessment, treatment, and support of a patient who has been strangled. Physiologic factors, risky behaviors associated with strangulation, strangulation as a component of IPV, and nursing implications are reviewed.

Medical Radiographic Imaging Recommendations

“When a victim of non-fatal strangulation presents to the emergency department it is critical for the medical provider to rule-out potential life-threatening injuries,” said William Smock, M.D. the Police Surgeon for the Louisville Metro Police Department and the Chair of the Institute’s Medical Advisory Board.  The Board today, with unanimous support from their expert physicians, released Medical Radiographic Imaging Recommendations, based on the latest medical literature, for hospitals and medical providers across America. “The goals of the recommendations include calling for doctors to evaluate the carotid and vertebral arteries for injuries, the bony/cartilaginous and soft tissue neck structure, and the brain for anoxic injuries,” said Dr. Smock. “The recommendations have already been implemented and adopted by more than 100 hospitals and academic emergency medicine programs around the world,” said Dr. Smock.

Strangulation Bibliography 2016 

The Institute on Strangulation Prevention would like to thank the following people for their contributions to this bibliography: Dr. Dean Hawley, Dr. George McClane, Dr. Ellen Taliaferro, Dr. William Green, Dr. Ralph Riviello, Dr. William Smock, Dr. Michael Weaver and Dr. Annie Lewis-O’Connor. The Institute also thanks the Boise State University School of Nursing for their collaboration on this project, especially Associate Professor Max Veltman and Michael Gerritsen. A special thank you to Rebecca Lovelace for making our collaboration possible.

Strangulation Legislation Chart 2017

This list was last updated by the Training Institute on Strangulation Prevention in May 2017. The list was originally created by the National District Attorneys Association and has subsequently been updated at various times with the help of Gael Strack, Casey Gwinn, Melissa Mack, Sarah Dawe, Sarah Sherman Julien, Elizabeth Consentino-Vonderahe and Fiona Wells. The Institute recommends checking both case law and current legislation for any updates or modifications.

 Cover California Strangulation Manual copyV2The Investigation and Prosecution of Strangulation Cases Manual

Strangulation impacts all professionals working on sexual assault, domestic violence, dating violence, and stalking cases.  Today, it is understood unequivocally that strangulation is one of the most lethal forms of domestic violence.  “The Investigation and Prosecution of Strangulation Cases Manual” looks at all aspects of strangulation crimes including, strangulation laws, how to investigate strangulation cases, how to prosecute strangulation cases, working with medical evidence in strangulation cases and more.

DVReport Cover

Domestic Violence Report, A special issue on Strangulation, August/September 2014

The Domestic Violence Report is a publication of the Civic Research Institute.  In this special issue, Editor Kelly Weisberg writes, “We are delighted to present this special issue on Strangulation, a topic of great interest because of the importance of the issue today, particularly in light of the high lethality of these cases, the profound consequences for survivors and the challenges for law enforcement. We are especially pleased that Gael Strack and Casey Gwinn are Guest Editors.  These two former prosecutors are leading experts on strangulation as well as founders of the Family Justice Center movement.


Intimate Partner Violence: A Health-Based Perspective

© 2009 by Connie Mitchell
Ellen Taliaferro, M.D., Dean Hawley, M.D., George McClane, M.D., and Gael Strack, J.D.Strangulation, a common form of intimate partner violence (IPV) assault, is one of three major types of intentionally inflicted neck trauma: blunt impact trauma, penetrating injuries, and strangulation.

Screen Shot 2015-10-02 at 10.49.51 AMNon-Fatal Strangulation Is an Important Risk Factor for Homicide of Women

Journal of Emergency Medicine, 2008, 35.3
Nancy Glass, Ph.D., M.Ph., R.N., Kathryn Laughon, Ph.D., R.N., Jacquelyn Campbell, Ph.D., R.N., Carolyn Rebecca Block, Ph.D., Ginger Hanson, M.S., Phyllis W. Sharps, Ph.D., R.N., and Ellen Taliaferro, M.D., FACEPThe purpose of this study was to examine non-fatal strangulation by an intimate partner as a risk factor for major assault, or attempted or completed homicide of women. Interviews of proxy respondents and survivors of attempted homicides were compared with data from abused controls.


YourPatientYour Patient. My Client. Her Safety: A Physician’s Guide to Avoiding the Courtroom While Helping Victims of Domestic Violence

DePaul Journal of Health Care Law, Symposium 2007, 11.1
Gael Strack, J.D. and Hon. Eugene HymanBecause victims will sometimes seek help from the medical community first, physicians need a basic overview of the law, legal issues, and understanding of victim rights and resources. Alternatively, attorneys need a basic overview of medical issues and understanding of domestic violence injuries. Victims need support and referrals from their physicians. They need advocacy from shelter providers and community based organizations to help them stay safe. They need access to legal assistance from attorneys to protect their rights. They also need abusers to be held accountable by the judicial system. Domestic violence is everyone’s responsibility.


From Hippocrates to HIPAA: Privacy and Confidentiality in Emergency Medicine – Part I: Conceptual, Moral, and Legal Foundations

Annals of Emergency Medicine, 2005, 45.1
John C. Moskop, PhD, Catherine A. Marco, MD, Gregory Luke Larkin, MD, MSPH, Joel M. Geiderman, MD, Arthur R. Derse, MD, JD
Respect for patient privacy and confidentiality is an ancient and contemporary professional responsibility of physicians. This article outlines the basic concepts of privacy and confidentiality, reviews the moral and legal foundations and limits of these concepts, and highlights federal privacy regulations implemented under the Health Insurance Portability and Accountability Act of 1996.

From Hippocrates to HIPAA: Privacy and Confidentiality in Emergency Medicine – Part II: Challenges in the Emergency Department

Annals of Emergency Medicine, 2005, 45.1
John C. Moskop, PhD, Catherine A. Marco, MD, Gregory Luke Larkin, MD, MSPH, Joel M. Geiderman, MD, Arthur R. Derse, MD, JD
Part II highlights specific privacy and confidentiality issues encountered in the emergency department (ED). Discussed first are physical privacy issues in the ED, including problems of ED design and crowding, issues of patient and staff safety, the presence of visitors, law enforcement officers, students, and other observers, and filming activities. The article then examines confidentiality issues in the ED, including protecting medical records, the duty to warn, reportable conditions, telephone inquiries, media requests, communication among health care professionals, habitual patient files, the use of patient images, electronic communication, and information about minor patients.

NoPlaceNo Place for a Smile: Domestic Violence

Journal of the California Dental Association, May 2004, 32.5
Casey Gwinn, J.D.; George E. McClane, MD; Kathleen A. Shanel-Hogan, DDS, MA; and Gael B. Strack, J.D.Because dentists routinely assess a patient’s head, neck and mouth, they have a unique and excellent opportunity to recognize whether or not a patient is being abused. This article seeks to enlist the collaboration of the dental community in the effort to prevent domestic/intimate partner violence and provide more information about the signs and symptoms of domestic violence injuries, including strangulation

JEMWalking and Talking Victims of Strangulation. Is There a New Epidemic? A Commentary.

Journal of Emergency Medicine, 2001, 21.3
Ellen Taliaferro, M.D., FACEP, Trevor Mills, M.D., and Sharon Walker, R.N., MPH, Ph.D.This issue of JEM presents five articles addressing the issue of manual strangulation in surviving victims of intimate partner violence (IPV). These landmark articles reveal to the medical community what the social services and advocate community has known for a long time: strangulation, or throttling, is a common means of domestic violence inflicted upon victims by their perpetrators.

Survey Results of Women Who Have Been Strangled While in an Abusive Relationship

Journal of Emergency Medicine, 2001, 21.3
Lee Wilbur, M.D., Michelle Higley, M.D., Jason Hatfield, M.D., Zita Surprenant, M.D., MPH, Ellen Taliaferro, M.D., Donald J. Smith, Jr., Ph.D., and Anthony Paolo, Ph.D.Few studies attempt to examine individual methods of domestic abuse. The objectives of this study are to evaluate strangulation as a method of domestic violence abuse: to determine the incidence of strangulation occurrence within the cycle of domestic violence, the subjective medical symptoms experienced by victims of intimate partner strangulation, and the elective utilization of health care following a strangulation incident

A Review of 300 Attempted Strangulation Cases, Part I: Criminal Legal Issues

Journal of Emergency Medicine, 2001, 21.3
Gael B. Strack, J.D., George E. McClane, M.D., and Dean Hawley, M.D.Three hundred strangulation cases, submitted for misdemeanor prosecution to the San Diego City Attorney’s Office, were evaluated to determine the signs and symptoms of attempted strangulation that could be used to corroborate the victim’s allegation of being “choked” for purposes of prosecution. The study reveals that a lack of training may have caused police and prosecutors to overlook symptoms of strangulation or to rely too heavily on the visible signs of strangulation.

A Review of 300 Attempted Strangulation Cases, Part II: Clinical Evaluation of the Surviving Victim

Journal of Emergency Medicine, 2001, 21.3
George E. McClane, M.D., Gael B. Strack, J.D., and Dean Hawley, M.D.Medical literature describing victims who survive strangulation is scant. The majority of articles on strangulation are found in the forensic literature, describing the post-mortem findings on autopsy. This article presents a suggested protocol for the evaluation and treatment of the surviving victim of strangulation, based upon a review of the available literature. It also corroborates the findings of Strack et al., in the study by the San Diego City Attorney’s Office, described in Part I of this series.

A Review of 300 Attempted Strangulation Cases, Part III: Injuries in Fatal Cases

Journal of Emergency Medicine, 2001, 21.3
Dean A. Hawley, M.D., George E. McClane, M.D., and Gael B. Strack, J.D.A review of 300 cases of alleged strangulation assault, submitted for misdemeanor prosecution by the San Diego City Attorney’s Office, led to a search for medical evidence that would be useful to prosecute these cases (see Strack et al. in this issue of the Journal). The injuries identified in these non-fatal cases are similar to injuries found in fatal domestic violence strangulation assaults. This article reviews the injuries recognizable at autopsy in cases of strangulation in domestic violence victims.

Frequency and Relationship of Reported Symptomology in Victims of Intimate Partner Violence: The Effect of Multiple Strangulation Attacks

Journal of Emergency Medicine, 2001, 21.3
Donald J. Smith, Jr., Ph.D., Trevor Mills, M.D., and Ellen H. Taliaferro, M.D.The objective of this study is to examine the correlation between the number of times a victim of intimate partner violence (IPV) has been strangled and symptom development subsequent to the attacks. One hundred and one female subjects responded to a series of questions regarding the history and characteristics of the strangulation and the development of specific medical symptoms.