Because physical injuries are often absent or overlooked, strangulation has often been a difficult crime to prosecute. But, in the 1990s, a team of law enforcement leaders in San Diego reviewed the medical examinations of 300 strangulation survivors to identify common symptoms. George McClane, a forensic medical examiner, and Gael Strack, a former assistant district attorney who is now the executive director of the San Diego Family Justice Center, published the results of the study. The results can be used by police to determine when a mandatory arrest is appropriate and by prosecutors to gather evidence for prosecution. The symptoms listed include faint pressure marks behind the ears, a raspy voice, bloodshot eyes from burst blood vessels, involuntary urination or defecation, and difficulty breathing or swallowing. Even where physical evidence is seemingly absent, medical personnel can use equipment to look for bruising or swelling of the throat and for bleeding in the eyes.

McClane notes that strangulation is an intentional act that is a serious crime, distinguished from choking, which is "an accident that happens when food becomes lodged in the windpipe." Strangulation can kill immediately, or it can kill hours or days after the event. It can also cause brain damage. Reports of strangulation must be taken seriously by first responders, police, medical personnel, advocates and prosecutors, and victims must be made aware of the danger that it presents.

Compiled from: Tessier, Marie, "Responders Learn to Spot Signs of Strangulation," Womens eNews, 19 December 2005.