What Every Advocate Needs to Know About Strangulation

hello everyone and welcome to today's presentation my name is ashley ramschlag i'm the vice president of digital services at teresa's fund and domestic shelters.org today we're delighted to be joined by gail strack for a presentation on strangulation and domestic violence so just a couple of housekeeping items to go through before we get started so closed captionings not available slide please all right and just a reminder that all attendees are in listen only mode if you have a question for the presenter please put that in the q a box if you have if you'd like to communicate between attendees please use the chat function for that or if you notice there's something going on with the webinar if you're having any technical issues please leave a message there certificates a transcript recording and any additional resources will be emailed to all attendees within the next week if you're a call-in listener uh please give me an email at ashley domesticshelters.org and i'll make sure that you are on the participants list all right and everyone here i hope is familiar with domestic shelters.org and the resources that we provide but if not just a quick overview we are the the fastest growing online resource serving a little over 2 million people every year with domestic violence information we host and maintain a searchable database of over 2 800 domestic violence programs throughout the u.s and canada and if you're a service provider and you're not sure if you're in our database just give me an email at actually at domesticshelters.org and if you're a us-based program you can set up a wish list as well that allows people from anywhere in the world to send items directly to your shelter shelter or program so and don't forget we also have a facebook community we'll put a link to that in the chat box we hope that you'll join there it's a great place to network with other domestic violence professionals and then we have one more announcement uh up next uh so next thursday uh we will be presenting uh the webinar on how to cultivate clarify and connect with your resilient story with stacy brookman so we'll be talking about how to how how to help your clients write their stories out in a way that helps them to heal and that is next thursday at 1 pm eastern 10 a.m pacific and you can find more information about that at domestic shelters.org events we'll also drop a link in the chat all right next and without further ado i'll introduce our today's presenter uh so gail strock is the chief executive office officer and co-founder of alliance for hope international the alliance oversees the national family justice center training institute on strangulation prevention camp hope america voices and the justice legal network gail is an internationally recognized expert in non-fatal strangulation cases and regularly trains on numerous topics gail is also an adjunct professor at california western school of law teaching classes on domestic violence and the law so it's our honor and privilege to welcome gail strack oh this is well attended so thank you all for joining us looks like we have 740 no and it's still fifty three pieces people are coming and that's wonderful because this needs to get out so i'm gonna jump right in it because we only have 60 minutes together and we want to have time for questions the reason i am here is because back in the late 1900s 1995 i was in charge of our domestic violence and child abuse unit prosecuting cases of domestic violence in the city of san diego and it was my turn now to be the supervisor as casey gwen who was our supervisor at the time was on his way to become our elected city attorney and i just had one goal with everything that was happening in our community we had a db council we had specialized prosecutors we had a dv court we had specialized law enforcement our dv council had a protocol for everything our advocates were amazing we had it together i thought until march when i got this phone call from sergeant ann o'dell she called to tell me that we had suffered our first domestic violence homicide of the year that evolved cassandra stewart who was 17 years old at the time and a young mother at the time and i asked what happened and she told me that cassandra had been stabbed to death in front of her girlfriends and her girlfriends were her safety plan and i asked about that history of domestic violence and sure enough two weeks prior cassandra had called the police to report that her ex-boyfriend had just choked her the case never got submitted for prosecution because there was no visible injuries she was already recanting at the scene and minimizing so under our protocol the case was closed and never submitted for prosecution and you can imagine my heart just sank at that moment the guy even stopped breathing and so i asked the sergeant to meet let's have an informal death review and find out why that case didn't get submitted for prosecution what can we learn what can we do differently but before we could meet again she gave me another call to now tell me we had our second domestic violence homicide of the year involving tamara smith who was 16 years old at the time and also a young mother and tamara was strangled to death then set on fire left on a dirt road for her mother to find her and my heart sank yet again and when i asked about the history of domestic violence i learned that tamra also called police this time a month before to report that her ex-boyfriend had choked her that case was making its slow way to the city attorney's office but for all practical purposes it wasn't prosecuted so what was it and something in my gut and all advocates have this gut something in my gut told me that these choking cases were different and we missed it and we could do better and as i tried to educate myself i realized that only the pathologists knew about non-fatal strangulation and strangulation i did some research and found out all of the articles were written about women who died as a result of strangulation very little to nothing was written about i need to switch off i'll just keep on going that's what you have to do so um i discovered that very little was known at that time about uh being strangled and now we know so much let me give you one highlight we know now that if you're strangled even one time you're 750 more likely to be killed by your abuser that abuser strangulation is the last warning shot my theme for today is something that our advocacy committee just came up with and that's always ask and always do more anytime we are working with a victim of domestic violence we have to ask has any pressure been applied to your neck by any means choking means different things to different people so we have come up with a new way of trying to uncover if someone had been strangled and i'm going to walk you through all of these key steps and important steps to remember when we're working with a victim of domestic violence who's been strangled but first i've got a poll question for you we've got 818 people now and we want to know how many of you have received strangulation training before today we now have a course a five-day advanced course on strangulation and we try to cover as much as we possibly can within those five days and we still have to hide slides so you can imagine the pain and suffering i have already gone through just to try to reduce the best of the best down to 16 minutes or less i had to slide slides like crazy so hopefully now we've got the results have you received training on non-fatal strangulation cases before today and let's see oh it's almost like a photo finish 44 said yes but most of you said no so this is good and i do want to highlight the fact that if you've gone to this training before by any one of our trainers thank you but you also know that you have to keep going to this training because we are continuing to learn and it takes a while to get this into your dna i had the chance to work with the national domestic violence hotline and work with some of the advocates there and we have this discussion the more we learn about strangulation the more we're comfortable about talking about it with a survivor they're going to be more comfortable sharing more information with you and all of us so i always like to start with gratitude and a grateful heart every morning and every night it helps me stay normal as normal you can be during covet but i want to acknowledge all of the survivors that i've had a chance to work with as ashley mentioned i'm a former prosecutor former defense attorney county council and also at our san diego family justice center iran with the help of attorneys and interns and advocates a very large restraining order clinic at our san diego family justice center so we had over 5 000 cases at that time and i'm also an adjunct professor and a professor and during that time i've had an opportunity and still work with survivors today especially through the training institute and our legal program called the justice legal network and here are the things that survivors have said to us over and over and over again so much so that it's a theme the biggest call that i get right now is from survivors who are cooperative who want the case to go forward and they feel that the professionals around them don't have the training don't get it don't understand and they're seeing too many cases that start off as being a felony being reduced to a misdemeanor they're also seeing cases that start off as a misdemeanor then get reduced so once they go through this and they realize the danger uh they need justice as part of their healing that's what i'm seeing in the work that i'm doing now and what broke my heart and probably what gives me the biggest sense of urgency right now is if they don't kill them they are robbing them of hope and or creating these long-term health consequences and so medical attention is on the top of my list we've got to keep our survivors alive and strangulation you're going to have a lot of internal injury not necessarily external injury and that's where everybody misses it we're all looking for and been trained to look for those visible injuries and then for some reason we know when we see a visible injury then we need to take it seriously but i'm going to share a couple of things that i've learned that that was a mistake we just have to identify the victim who was strangled and you have to assume that there is internal injury we got to get that medical attention and we got to get imaging so we can clear it i'm also learning from so many survivors who have those long-term health consequences who have traumatic brain injury they have a very difficult time being diagnosed and treated appropriately and they're spending hours and hours and getting referrals after referrals and i just talked to a survivor and she was adding it all up and it was really hundreds of appointments and still feeling that sense of fear not knowing what is wrong so they're spending time they're getting the run around and not only is the criminal justice system hard to navigate the civil system is hard to navigate and now i'm learning uh from the survivors how difficult it is to navigate the medical community so victims also don't understand and they want us as advocates as attorneys prosecutors even defense attorneys play such an important role here to advocate and to educate they need to know the danger about strangulation also language victims like to use the word choking but choking even means different things to different people strangulation they do not resonate with but if the victim uses and your client uses the word choking i would say tell me more about what that means to you so we can make sure we are clear so that's why we've gone to the phrase has anyone applied any pressure to your neck by any means and then is really understanding the inability to breathe what they experience what they thought was going to happen and most recently with all this jail and bail reform happening i'm getting a new theme from the survivors we are talking to because we also hold a meeting once a month and in fact we're having our national voices committee meeting uh today and this is a theme that's coming up across the country from the family justice center world is that they feel when they call the police they're not getting the support that they need and i'm also tracking how many women are being killed across the united states after dangerous men men who have strangled and when it comes to strangulation strangulation is a gendered crime so that grateful part i want to thank all of the advocates from across the united states that have joined our advocacy advisory committee at the training institute because of covet we knew we wanted to focus all of our attention and might when it came to this issue and create some new tools and resources for advocates out in the field but overall we need your help we need your help to bring awareness to improve policy and practice to have better outcomes for survivors and i still believe that offenders need to be held accountable for the crimes that they're committing and when you're talking about strangulation you are talking about in many cases an attempted homicide we're talking about an aggravated assault especially when someone is strangled to the point where they can't breathe and they think they're going to die unfortunately this training is still specialized meaning it's special training it's not core training so we have a long way to go and my goal now with 870 no 74 attendees is to multiply and you could share this information with others i think at the heart of it and why i've been so passionate about this because those two teenagers died under my watch and i promised their families that their daughters would not die in vain and we would try to figure this out and improve our response not only in san diego but across the united states so we now we are funded by the department of justice to be that clearing house to try to pull all this information for you so you can have immediate access to it so if you haven't visited our website please go to it and uh check it out our goal is to try to put something new something new on this website every single day just like what ashley is doing so we've got a lot of great materials for you under our dropbox called the last warning shot i wanted to make sure you were aware of this there's a lot of folders in there there's one folder in there just for advocates but there's also a folder that i call handouts that's print worthy so when you take a look at this dropbox go into it go to the handouts and start printing away i have to warn you our new big manual from california is big and it's hefty so you might want to pick and choose which chapter you like but our advocacy committee right now is creating a new improved chapter just for advocates and our goal is to get that out by the end of the year and the beautiful thing about dropbox it's kind of like the equivalent of a big binder at a conference the benefit is is that when we put something into this dropbox it just kind of continues to grow this dropbox has no time expiration so just keep it because we're going to be adding new materials to it if we improve something update something we'll take the old one out and put the new one in that's how it works so here's the big picture of what i'm going to give you i call it the best of the best that we have to offer starting with the law because a lot of folks don't even know about the law why this training is so important why you need to convince others to get this training understanding how lethal and dangerous this is medical consequences and then i'm going to give you some tips and if we do have time we're going to have bonus assessment but in case we run out of time you're going to have a copy of this powerpoint and then i would love for you to do your own assessment about your own community so what is the law good news one of the main reasons i feel we blew it in san diego is that we didn't have a law we didn't have a protocol we didn't have policy related to choking cases we didn't have any training nothing was included in any of the conferences i went to and at that time i was that eager beaver i wanted to learn as much as i possibly could about handling these cases because i knew it was a matter of life and death and those two two teenagers had a profound impact on my life and they're still in my heart every single day but finally we have advanced and we've got 48 states that have passed felony strangulation laws in some way or another only two states haven't gotten there ohio and south carolina and also d.c so we've got 20 tribes who've incorporated into their tribal codes we've got two u.s territories guam and virgin islands the federal code changed in 2013 and the military code changed in 2019. so why have all these laws passed i figured you might ask that because i've been asking that and i wanted to find at least one resource for you because this goes to the washington state and i want to brag about washington state so if you're from washington state your governor is about ready to sign a very historical law the first state in america that's likely to pass this law is going to be washington and the law is providing forensic exams for strangled victims and this is huge many states have been trying to pass this but we have not been able to do it washington is on the verge of the verge of the governor signing it and after that happens the barn door as far as i'm concerned has just been kicked open and we need to go fight for it in every state california tried this year yet again and we couldn't even get out of the gate but we didn't have washington as our secret weapon but washington also has great strangulation law and they put great legislative intent and i wanted to share this with you because i call it like you could sprinkle this language everywhere you go and you have a citation for it so here's what washington did when they passed their law they acknowledged how dangerous how lethal strangulation can be and so i'm just going to go ahead and read it for you because i know we have some folks that are listening in they said strangulation may result in immobilization of a victim may cause loss of consciousness injury or even death and has been a factor in a significant number of domestic violence assaults and fatalities while not limited to acts of assault against an intimate partner assault by strangulation is often knowingly inflicted upon an intimate partner with the intent to commit physical injury or substantial or great bodily harm they know what they're doing strangulation is a weapon of choice by offenders they know that they can get away with it if they have no visible injury but here's one of my favorite sentences that's included in the legislative intent strangulation is one of the most lethal forms of domestic violence why because you can cause somebody to pass out in a matter of seconds and die in a matter of minutes and here's why they determined and needed to be a felony because the particular cruelty of this offense and its potential effects upon a victim both physically and psychologically merit a felony offense so i love that legislative intent it's something that you can use in your tool box here's another one that i'm a big fan of california was able to pass this law in 2017 so when our police officers in california respond to a dv call they have a legal duty a legal duty a mandate a requirement to advise the victim if they find out that she has been strangled to let her know that this is lethal this is dangerous that she could have internal injury and that she should seek medical attention in our draft language we've also added recommending that victims talk to an advocate to assess their danger to do safety planning by definition now we know that victims who are strangled are at high risk it's what my gut told me back in 1995 and it's what your gut has been telling you all along and we have now danger assessment tools to use it in everything dr jackie campbell and all of the researchers who are leading this field every research article i have read put strangulation at high rest there's also a duty to track strangler so we all know who we're dealing with it with so um passing a law even though we have 48 states that have passed some form of felony strangulation law in some communities nothing is being done so we really need leaders to raise this discussion to ask what we're doing do we have a county-wide protocol and you have your assessment questions at the end so now i want to walk you through what happened in san diego what we learned in san diego and what i still think is happening across the united states in many jurisdictions so back to these amazing ladies who unfortunately had their lives cut too short what we learned we decided because there was no research out there that we were going to do our own research we ended up pulling or i should say i pulled first 100 cases then 200 cases then 300 cases and finally i stopped i got obsessed i go if there's no research out there there's got to be answers in looking at these police reports assessing them listening to 9-1-1 tapes looking at the comments that the victims said our follow-ups with our victim witness advocates what can we learn and this is what we learned we learned that system-wide we were unintentionally minimizing and trivializing strangulation cases from the time they called 9-1-1 all the way through the court so each one and even our unit who had received this award from the national council of juvenile and family court judges for the work we had been doing i realized we have been failing victims and that needed to change so i wanted to play at least not one 9-1-1 tape for you to also understand uh what we learned and how not only professionals were minimizing this but victims were unaware and unintentionally minimizing it as well hello yeah michelle this is san diego police department is this your husband or boyfriend is your husband do you have any weapons at all no what did he do to you okay i want you to try to take a deep breath and calm down he did what tried to break my neck and he suffocated me okay do you need a paramedic okay michelle do you need a paramedic are you sure okay he's inside your house all right he's not there with you he might be taken off in the car right now okay what kind of car would it be okay michelle i want you to take a deep breath and try to calm down okay he's don't have okay i'm okay are you sure if you can't breathe okay how come like i'm looking all right let me talk to the lady that was there again okay what's the name of the place okay there we go i'm gonna stop it there there's so many other 911 tapes that i listened to that really led to the conclusion how we were missing it but in that particular one it was very clear to me and i'm sure to all of you that she needed the paramedics to be called but she didn't understand what was happening the dispatcher didn't understand fortunately now as you fast forward there are protocols across the united states that require paramedics to be dispatched immediately when somebody finds out that the victim has been strangled starting from the dispatcher and in fact in texas there's a statute that requires the community to have a protocol a task force and that paramedics get dispatched so i think that is the key because they need immediate medical assessment because in our study we also found out that a lot of victims did not want to seek medical attention and that is true today for many different reasons but here's another reason why we were minimizing it is because 50 percent of the time there was no visible injury to the neck and we had been trained at that time to look for visible injuries to look for probable cause to arrest or to prosecute we did not understand that in strangulation cases most of the injuries are going to be internal and not external so that was one of the reasons we missed it the other reason is that ma few victims sought medical attention in my particular study it was only 3 so we needed to train the paramedics to let victims understand that they needed to be screened that they need imaging to rule out a carotid dissection to rule out a fracture or internal spelling that can cut off the airway and keep victims from breathing so the other thing that we learned is that the evidence was there all the time and we just didn't know it when you have an opportunity to analyze 300 cases oh my gosh it's just like it's all there we just didn't know there was redness to the neck there were tiny little red spots called petiquette which we now know is life-threatening injury in some cases when there was a follow-up we could see the bruising the next day so the injuries may not be present at that time but it would present itself later some of our victims had red eyes like they were bloody and they were bleeding the whites of their eyes were completely red or you might have a couple of spots we also found out that some of our victims were having seizure a lack of oxygen to the brain will trigger a seizure and so we missed that and didn't understand that that was all connected and we had some mere fatal strangulation cases as well where victims had urinated they passed out they defecated and that was something no one's going to tell the police or anyone else because it's too embarrassing and the list goes on i'll share a little bit more but i'm going to share with you the keepers my first instructor on strangulation i was lucky i got to meet dr dean hawley and dean hawley was one of those leading pathologists in america and he had already dedicated himself to being one of the faculty members at the national district attorney's association he was sick and tired of seeing so many people die wanted to share all of his experience with cases where there weren't murders to prevent a murder so you got to love him just for that so he would take my phone call and he would return it and he would just let me ask him all sorts of questions probably some dumb questions but here's a couple of things that i learned from him that's still true today he said gail if you're looking for visible injuries to prove your case you're going down the wrong path you have to understand that you could strangle someone to death and not leave a single external injury all the injuries are going to be internal and the best way to do that is an autopsy and i obviously said that's not going to work but let's work our way backwards if you were to survive based on those internal injuries that you see at autopsy what would be those signs or symptoms the other thing i had to learn that i never considered before as a prosecutor and defense attorney is that method is important and i kept thinking that if you apply pressure to the neck you were obstructing airway and i thought what's the big deal i mean i could jump in the pool i can hold my breath for a long time and i'm okay but little did i know that it can have long-term consequences that it's not just about obstruction of air flow it's obstruction about blood flow and it's a different thing when you're jumping in a pool versus somebody is cutting your breath off and you can't breathe so ultimately for those of you who are interested in research and you love to read the articles i've got a reading list for you but uh those that initial study turned out to be six articles in the journal of emergency medicine and i'm going to be just highlighting a couple of things that i think are relevant for advocates so dr wilbur took the lead on this study and this was the first time this had been done this was a focus group with survivors asking them about their experience going through this what could we learn from survivors and this is what they found out they ended up seeking volunteers from a shelter uh in los angeles and also in dallas texas and then we also pulled some volunteers from the hospital we discovered that strangulation was something that happens towards the end in other words everything that we learned about the continuum of violence domestic violence gets worse so on average strangulation and intimate partner violence happened about the three-year mark most of the victims said that they were threatened with death this was not something that someone was joking about they were communicating a message and they all said most of them that it was not just strangulation they were being beaten slapped kicked you name it they were experienced at all and 70 in that study felt that they were going to die the most recent study that came out 99 of the victims who were asked this question believed that they were going to die so that was a key and then also that this is why the medical attention is so important because things can get worse the swelling can get worse the internal injury can turn into a carotid dissection which can turn into a stroke which can turn into death and if you don't diagnose a traumatic brain injury because of that concussion or a lack of oxygen to the brain without a diagnosis you're not getting treatment and everything i've learned about the brain the sooner you treat the better so overall no visible injuries no training no laws no protocol caused us to minimize this so now quickly you all know this but for some of the folks who are new to this we got to be paying attention as the violence is increasing i think back in the day we all put strangulation right by a slap because no visible injuries just a redness a red mark but now we know that strangulation is that last warning shot before a homicide so that's one thing that we can communicate to a survivor to let her know that when strangulation presents itself at and in a domestic violence relationship it is the last warning shot so the next thing is it's still about power and control as all of you know when i have a chance to train police officers i tell them let's put penal code sections around all of these strategies and the power and control wheel that ellen pence and her colleagues came up with many years ago this power and control wheel is key and as i've been talking to survivors ruth uh really helped me understand she was one of our survivors at the family justice center when i was the director there she was part of our voices committee and we were doing one of those focus groups trying to understand trying to help other people understand how do we put this together in a victim impact statement and she made me realize that strangulation was a weapon of choice he did it intentionally to cause this amount of fear to let her know that he had the power to let her live or die and even though that she was begging and begging and begging for him to stop he kept on applying pressure until she passed out but that communicated something to her that all and she said it to me this way it was like something changed in him he knew he had that power to give me life or to give me death and i gave all my power away that was the first time i heard a victim say that and i've heard so many others now we could spend probably a whole hour on that particular issue but i also want to shift gears because there's a lot of research that's coming out now about coercer control laws which didn't start in the united states it actually started in other countries california just passed its coercive control law but as i'm reading this research by definition strangulation is coercive control i want to play this let me just on a very personal level i want to play this very short clip from a survivor she's also a senator she was trying to advocate for felony strangulation law in oregon she's also a doctor and i want you to hear how she described it and how she advocated for this law on a very personal note this has real significance to me many of you know that i'm a dv survivor myself in my first marriage and my abuser strangulation was one of his um abuse methods of choice shall we say to this day i'm grateful that i'm not a man and so dress wear for me does not include a tie because i can't even wear a turtleneck he would kneel on my chest he would put his hands around my throat i was fortunate that i never lost consciousness he would take me just to the brink and let me go it's been almost 30 years since i left him and i'm sitting here my heart rate's 130 and my blood pressure is up and this was more traumatic than any of the times he hit me any of the emotional abuse he perpetrated and every survivor will tell you the same story the inability to breathe is terrifying it is fundamentally terrifying because it's so basic to our ability to survive being hit is bad losing the ability to breathe is worse in a whole host of ways i was fortunate compared to a lot of other women i never lost consciousness which suggests i probably didn't get brain damage i made it through medical school stopped there because i think she made the most important point and when i heard her testimony i realized that we could do better we could do better to document how terrorizing and what victims were going through especially in that victim impact statement when they want judges and others to know what is happening to them and the research is now very clear strangulation is terrorizing and terrifying uh susan sorensen who is just amazing in the work that she's doing she did an article in 2014 which really put the equivalent of strangulation to torture and to waterboarding so it's wonderful to see that we're finally getting it in the research and in practice overall i decided to include this slide this is what victims have been saying these are the things the level of fear they're describing as deep horrific paralyzing and they really talked about how important it is for all of us to understand and educate ourselves to be able to talk to them about it and as you know they feel that overall we need to believe them and a lot of professionals don't believe victims because there's no visible injury so that's why the training is so important and then they talk about the level of trauma and how everything gets jumbled as a former prosecutor when i would hear that jumbled memory i thought about credibility i go how are we going to portray this victim as credible but i didn't receive the trauma-informed training then that i have now now i know that you have the jumbled memory it's actually evidence that a prosecutor can use it is evidence of trauma that cooperates and gives more credibility to the victim not less and of course they all talked about concern for their children going through what we've described in one of the articles as the stages of death and to a person when we started to change our questions and i would ask what did you see thinking that they might talk about altered state of consciousness all of them kept talking about the eyes of their abuser their attacker how they were dark and beady so understanding lethality is key we've learned now from all the studies that if you're strangled one time you're 750 percent more likely to be killed the last big study that dr campbell did with all of her colleagues where they use a risk assessment tool by police officers this is probably one of the largest study to date analyzing risk assessment and strangulation they found that 80 of them were at high risk they had strangulation and what they also discovered is that when victims do call the police is because they need the police to intervene many of them reported being strangled multiple times as the way jackie said the more they're being strangled the higher the risk she estimates that quite frankly you're probably closer to a thousand times more likely to be killed and most recently for those of you who like research jackie campbell updated her d.a assessment tool in 2019 to give strangulation three points and not one point and this article substantiates and validates that change that was made in the da assessment now casey gwen is my colleague we are co-founders of the alliance and the institute and one of the things that as we've been doing this work together he's identified and this is his meme that men who strangle women are the most dangerous men on the planet we've been tracking this and doing some research on our own to find out when officers have been responding to db calls we know that some of them have put their lives on the line and they have been killed they have been killed and what we have discovered is that men who end up attacking and killing police officers as well also have that history of domestic violence and strangulation and we're finding them in mass shooters so the point is is that while not every strangler is going to kill we've been having a hard time finding a killer who hasn't strangled so now i always want to highlight a couple of things when it comes to strangulation and all the statues we're really talking about pressure to the neck that's going to be strangulation and you're applying it continuously someone will pass out about 10 seconds and you can have death if you block off blood flow you're going to die quicker if you block block off air flow that's going to take longer and suffocation is when you are covering or blocking the nose or mouth and making it difficult to inhale and breathe so at this point i definitely want to say strangulation is not choking choking is something that is accidental not intentional there's a reason why the neck is so vulnerable and once you understand how it's not protected like the brain that it all of these important arteries and veins because arteries will take the good blood to the brain the brain has like a small gas tank about 10 seconds it's using up every oxygen that it can get if it's deprived even for a second it's going to have an impact and also there is literally what's called bad blood that has to go down the veins and then circulate get back to some good air and everything kind of works like great plumbing and if you all know what happens when you block plumbing you got a problem plumbing problem you also have the highlight bone thyroid cartilage cricoid cartilage and tracheal rings we are now finding that victims who are strangled and survive can have damage to all of these vital structures and look at the vein right there it's right there it's extremely vulnerable covered by the skin so it's easy to compress or obstruct the veins and also doesn't take much pressure to obstruct the blood flow to the brain but what i'm learning and what we learned in our focus group that we had to take to our medical committee is a lot of our victims are reporting issues with their thyroid and they're seeking medical attention as a result of their thyroid and the thyroid is right there on the front of the neck and if you squeeze it you put pressure on it it releases all these hormones i mean the thyroid is an important part of the body because it kind of regulates everything and you can have what's called thyroid storm and because the damage that can be done you can actually die for thyroid storm so the other piece is loss of consciousness i'm of the opinion now that more victims have passed out and just don't know it because the first thing to go is going to be memory i learned about the hippocampus the hippocampus is responsible for recording memory and if the hippocampus is not getting oxygen it's not working and it's not recording and there's no test for loss of consciousness so a lot of victims if you ask them did you pass out they're going to tell you yes no i don't know but all we're asking is either yes or no and most of them really don't know because they don't remember so you have to look for signs or clues well what did you feel and they'll report some dizziness stunned disoriented i saw stars it went from color to black and white now i can't remember what do you remember i remember where the argument started and i remember where it ended and i can't explain why i got from one location to another that's a clue and we know from studies that if you already have this altered state of consciousness it only takes about another one to two seconds and then literally you have passed out so that hippocampus is key and explains one that they have suffered internal injury and probably have a traumatic brain injury dr bill smock who's our medical director working with a shelter in illinois the hope center created this document to really help explain what happens when you block off blood flow you can have loss of consciousness within seconds you can have a seizure you can urinate within 15 seconds you have defecation in 30 seconds and literally in less to two minutes you can cause someone to be killed so i do want to share that with you and seeing ashley i think i've just gotten my warning signal that we're coming towards the end so i'm going to keep going like i got four more minutes uh signs and symptoms in our resource library and in the drop box you're going to have this tool to help you identify all the signs and symptoms and they're the same whether it's an adult or a child so i want to highlight the symptoms because your victims may not have that visible injury first of all voice changes it could be raspy uh they can lose their voice completely they have trouble swallowing uh they start to cough they're having difficulty breathing things are getting tight and things are getting worse because of the internal swelling they can also have behavioral changes that lack of oxygen to the brain makes them more combative not less combative so that might be one reason that someone like a police officer may identify the wrong individual as the dominant aggressor they're the ones that appear hostile or may even appear to be under the influence of drugs or alcohol but have had neither and check this out the symptoms of a brain injury lack of memory problems concentrating problems sleeping headaches depression anxiety doesn't that all sound like ptsd yes so our victims could have ptsd and evidence of a traumatic brain injury and may not even know it i will end with tanika and then open it up for questions you will have access to my entire powerpoint my goal was to get as far as i could and share as much as i could but i think this will bring it home tanika was a survivor she was a nurse and she's given us full permission to share this story with others because she wants others to know tanika was strangled two times the second time she decided to call the police and uh leave she thought she was gonna die there was an argument he comes out of nowhere from the back grabs her in a choke hold and she said it felt like he was trying to rip my head off she felt a tremendous amount of pressure she got dizzy disoriented couldn't even tell if she passed out or not but sought help got called to the police got to the family justice center this is six days after being strangled the advocate and the detective both who were trained insisted that she seek medical attention she goes look i'm a nurse i'm fine i'm fine i've got no visible injuries on my neck i have no symptoms i do not need to go but they wouldn't take no for answer long story short she seeks medical tension she gets to the hospital people are advocating for imaging she gets the imaging and it comes back with bilateral carotid dissection that means she had damage to both of her arteries and she could have stroked and died at any moment fortunately dr bill smock and all of our medical advisors have figured this out and come up with recommendations going back to 2016 recommending that victims get imaging in order to rule out internal injuries so what we need is for you to ask and do more to document when you find out to look for those clues encourage medical attention offer hope and you can offer hope in so many different ways resources okay because hope also the science of hope and educating victims about hope can mitigate that trauma giving them resources understanding what they need to know and navigating the medical and also the legal system risk assessment and just taking the time to educate them so with that i know i am uh officially out of time i could keep going for another hour but i know ashley wanted me to stop right at 10 50 to take some questions so that's we're going to do see my alarm went off so we are right on time i can breathe now so questions should i go ahead and look in the all right so i'll take them looks like tammy thank you for your question or some medical providers mandated to report yes they are but as you know uh when it comes to domestic violence not every state has a duty for medical providers to report domestic violence sexual assault yes child abuse yes elder abu ucs but not domestic violence i think the last time i checked there was only one state that specifically included strangulation so many of our medical mandated reporting laws are very old and have not been updated to include your strangulation law to report so some of the states just have a duty to advise victims about their rights and connect them to an advocate so it varies from state to state thank you for asking that question uh tammy let's see margaret isn't it true that if their breathing is compromised during strangulation it is a felony it is a felony now does everybody understand that it's a felony maybe not a lot of folks will ask victims were you able to breathe well i'm breathing now so the answer is yes but we need to determine whether or not there was any obstruction any difficulty breathing so i like to use a scale scale from one to ten you can say one um being normal did your breathing change in any way did you have any difficulty if it was normal great and if you had difficulty how much difficulty did you have how much pain did you experience from one to ten so this is where doing an assessment and finding out what your prosecutors are doing would be helpful next patty we have had three children under 10 who have been strangled by a parent or sibling in the last three weeks this is new for us have you seen trends regarding children i would say the children have been strangled just as long as victims have been strangled we have been missing it in the child abuse world cps world because little kids have difficulty explaining what happened to them so we do have in our resource library some great webinars on pediatrics regulation because with little kids because they're still developing it's kind of like squeezing plastic they're not going to have that same internal injuries that someone might older might have but they're going to have more brain damage and consequences and in that community very few people have received training so thank you for bringing it up do you have any info uh graphs infographics or info topics that have a picture of a person with darker skin yes thank you for asking that we do as i said i had to hide so many slides but thanks to fernanda who is part of our team we'll put access to it and i'm pretty sure it's in our dropbox if not we will make sure it's in the dropbox we're also trying to translate all of our materials not only in spanish but in other languages what are the states that have not passed the law yet ohio and south carolina um and also uh washington d.c but the states have to do with ohio which is trying right now and south carolina also trying okay jim let's see what kind of impact are you noticing with your clients due to the graphic evidence presented during the derek shavin trial how are you dealing with this you know that's a very good question i don't know if i have an answer to it but i think i can answer it in this way during this past year with the trial with covid and everything that we've been experiencing i think we are all all of us experiencing community-wide trauma we are also seeing higher levels of domestic violence i'm getting reports from all of our family justice centers that their staff trigger victims are triggering that they're seeing more strangulation and by my calculation we're seeing more homicides more homicides and suicides and the last time i checked when men murder women over the last five reports that i read we're seeing an increase a minimum of 20 percent across the united states and in some jurisdiction homicide rates are increasing by 50 percent so kimberly is there any canadian stats or changes in the law canada is doing a lot of great work they're starting to pass their strangulation laws and starting to do some research i actually found a research article that was done at a shelter and it's really about the lived experiences of strangled victims and one of the things i noticed in their study and talking to survivors we're seeing the same thing learning the same thing from their survivors in canada as we're learning here and they're all saying please ask us please share this information please educate us and please advocate for us this is a felony and this is a way where we can intervene and prevent a homicide from occurring this regulation work to me is homicide prevention i will make sure that we put in some canadian research that i've gathered into the dropbox there's actually one case that i love is called the lemon case and i say sprinkle a little lemon everywhere some of the language from that case in canada is just brilliant so let's see the next one can you have bruising inside your throat that's not visible without an exam i've had that come up recently where client thought they had bruising from being strangled internally well it's an interesting thing and this requires yet probably another 15 minutes but it all depends on the imaging that is being utilized because you have cts you have ctas you have mris and you have mra and sometimes they do the imaging to the head because they're talking about a concussion they may not do it to the neck and then i've realized that not all radiologists are really good at identifying the internal injuries so very complicated there there uh they are finding in some research that the mri and the mra is very good at identifying the same injuries that a pathologist can identify at the time of an autopsy there's also some imaging that goes inside the throat with the video camera that can identify that swelling and bruising and also petechiae inside the throat let's see chris if gail could compare and contrast strangling and smothering i would be grateful i've talked to violence users who believe smothering covering someone's mouth or nose while sitting on top of them for example is less dangerous than strangling i've talked to survivors that said it is different but just as terrifying well i think that's sums it up it is different but just as terrifying in other words you can still cause somebody to pass out you could still cause somebody to think that they're going to die and have that near death experience you could still have damage internally you can still die when you are obstructing air flow to me i think it's a longer more painful terrorizing process to feel yourself not being able to breathe and it's slow and slow and you know what is happening i mean i i don't want to refer to it but a good example is the george floyd case horrible we all saw but we all saw how painful and devastating it was to have someone sit on top of you put pressure on your neck put pressure on your back making it difficult to breathe that's called positional asphyxia when it comes to blood flow everything happens much quicker it's different but the same because at the end you still have anoxia you still have the condition of assyxia and you can still die can you please remind me of what washington state is on the verge of passing kerry thank you so much because i wanted to say that again washington is going to pass the first law on forensic exams for the strangled victim it provides for them to come up with best practices a protocol they're going to cover the cost of those exams and it passed both the house and the senate unanimously there was no argument new york has tried to fail texas has tried and failed arizona has tried and failed california's tried and failed and we couldn't do it so what washington is doing is awesome and i'm going to be bragging about washington forever but they're going to help us the rest of us pass our law so james asked any specific recommendations or techniques to help assist victims who are recanting or minimizing the event thank you james i i think you know the answer to this one too i have found that family justice centers where you have all the professionals at the same location where they've all been trained they all know about trauma-informed interviewing you have advocates to support them you have advocates to educate them you have advocates to go to court with them when i was at san diego family justice center i saw a dramatic reduction in victims recanting however another way of handling this is that everybody does their job so well it doesn't matter if the victim recounts so what if the 911 dispatcher is trained the paramedic the police officer detective the prosecutor defense attorney the courts the probation officer and they're all saying the same thing and understand it you're going to win those cases and there's also a thing called forfeiture by wrongdoing where you can still win cases without the victim's testimony going to court is traumatizing so if you can win this case and we win cases all across the united states and murder cases and the victims never testify we should be able to do it in non-fatal strangulation cases has joined again and i call that a clue that means uh we have run completely at a time but as i promised ashley that i would take any uh unanswered questions answer them for you and then send them back to ashley which he can share but uh thank you all for joining us it's very as you know personal to me doing this training oh every once wow it kind of creeps up those two teenagers so when i get to train i'm living up to my promise to their parents that their daughters didn't die in vain so thank you for joining us thank you gail we really appreciate this has been fantastic information and thank you to everyone who tuned in today uh just a quick reminder we will record this webinar was recorded and we'll send that along with the certificate of attendance transcript and any resources within a week um and anyone that's logged or that's called in please do send me an email at ashley domesticshelters.org with your email address so i know where to send that information and don't forget to register for next week's webinar about writing for your resilience on thursday may 13th and you can visit domesticshelters.org events for more information on that with that we will conclude today's presentation thanks everyone take care

Channel: domesticshelters.org

Views: 9,524

Keywords: strangulation, traumatic brain injury, domestic violence, domestic abuse, gael strack, training institute strangulation prevention, intimate partner violence

Id: QmBdUo1SEB8

Length: 61min 19sec (3679 seconds)

Published: Wed May 12 2021