County Warns Medical Community About Strangulation

In an effort to save the lives of people who find themselves in physically abusive relationships, the County Health and Human Services Agency issued an advisory to the local medical community about strangulation, one of the most lethal forms of domestic violence.

The advisory informs San Diego County health care providers about the risks of intimate partner, nonfatal strangulation and provides links to resources and recommendations on what to do when they spot signs and symptoms.

Between 2007 and 2017, the San Diego County Domestic Violence Fatality Review Team, which is led by the San Diego County District Attorney’s Office, examined the deaths of 122 women who were killed by an intimate partner. The review determined that 13 percent included strangulation as a contributing cause.

“Recognizing the signs and symptoms of strangulation during a history and examination of at-risk patients can save lives,” said Kristi L. Koenig, M.D., medical director for Emergency Medical Services at the County Health and Human Services Agency. “Intimate partner, nonfatal strangulation is a strong indicator that an abusive relationship could turn fatal.”

The advisory made the following recommendations to the local health care community:

  • Perform intimate partner violence screening on vulnerable patients and those with suspicious symptoms or injuries.
  • Recognize signs and symptoms of nonfatal strangulation.
  • Be aware that many patients may have no external findings but could still have symptoms consistent with strangulation.
  • Evaluate for injuries to the carotid and vertebral arteries, the bony/cartilaginous and soft tissue neck structures and the brain.
  • Report suspected domestic violence cases to law enforcement.
  • Offer resources to at-risk patients, friends or family members.

San Diego County has been a pioneer in the detection and prosecution of strangulation cases. Intimate partner homicides decreased by 50 percent countywide from 2015 to 2017.

The San Diego County District Attorney’s Office and Palomar Health, Forensic Health Services found that evidence collection in strangulation, and other serious domestic violence injuries, by trained health care personnel increased the filing of felony charges by 30 percent. The DA has also worked with local law enforcement agencies to implement a standardized, countywide strangulation protocol to further aid in these investigations.

“Strangulation is the ultimate form of power and control within an unhealthy, violent intimate partner relationship,” said District Attorney Summer Stephan. “This leadership from medical professionals in spreading awareness and encouraging expanded training on the signs and symptoms of this often lethal crime is key to reducing these deaths.”

If you or someone you love is a victim of domestic violence, contact the National Domestic Violence hotline at (800) 799-7233.  Locally, 24-hour domestic violence help is available by calling 2-1-1 San Diego.

José A. Álvarez is a communications specialist with the County of San Diego Communications Office. Contact