Nonfatal Strangulation a Potential Predictor of Deadly Violence

Victims of intimate partner violence who endure a single nonfatal strangulation are 700 percent more likely to be victims of homicide than those who do not experience such strangulation.

Heidi Gilbert learned this startling statistic during a weeklong course with the Training Institute on Strangulation Prevention.

“I really had my eyes opened to how predictive this is of later homicide,” said Gilbert, a clinical educator in the emergency department and Sexual Assault Nurse Examiner Program coordinator at Stillwater Medical Center in Oklahoma. “It’s one of the few mechanisms of injury and crimes that can be perpetrated that most often leaves no external signs and are very dangerous and easily fatal.”

During a session today (Oct. 1), Gilbert will share signs and symptoms of nonfatal strangulation, what makes strangulation so deadly and how to document nonfatal strangulation cases seen in the ED. An advocate for victims of sexual assault and domestic violence, Gilbert draws inspiration from her own experiences after her sister was killed in a domestic violence homicide in 2013.

“I have tried to use that tragedy to educate nurses, law enforcement, the lay public and anybody I can,” said Gilbert, a co-chair of the ENA Conference Education Planning Committee. “If I would have known then what I know now, I don’t know if the outcome would have been different, but I wish I would have known then what I know now.”

 “The Edge of Homicide — Nonfatal Strangulation and Nursing Implications” session will be from 10:15 to 11 a.m. Mountain time in the Four Seasons Ballroom. It will be livestreamed from Denver for those who have registered for Digital Access. 

The signs and symptoms of nonfatal strangulation are often missed in the ED because many emergency nurses haven’t been trained for this scenario.

“It is very important for ED nurses to know what to look for, to know what to ask, to know what normal behavior is for a victim of trauma,” Gilbert said. It’s also important to know how to advocate and have a grounding in the evidence-based standard of care for these patients, she added.

Strangulation is a predominantly male-perpetrated crime, she continued, although like other forms of domestic violence, it transcends geographic, financial and societal boundaries.

“Whether nurses work in very rural areas, or in underserved, lower socioeconomic areas, or if they are in the wealthiest areas, they are going to see domestic violence and likely strangulation patients, so this is relevant to any emergency nurse,” Gilbert said. “Any ED nurse is probably going to encounter this at some point.”