LANGUAGE AND DEFINITIONS
—Abrasion (scratches and scrapes): Superficial injuries to the skin that are limited to the epidermis and superficial dermis. Abrasions are normally caused by rubbing, sliding, or compressive forces against the skin.1 A variety of traumatic abrasions may result from strangulation:
—Chin abrasion: Incurred when, in an effort to protect the neck, the victim instinctively lowers the head and creates a compression sliding of the chin against whatever is applying external pressure to the neck.
—Impression mark abrasion: Occurs when fingernails abrade the skin leaving a curvilinear (ie, semicircular) mark(s).
—Ligature mark abrasions: Typically horizontal abrasions left on the neck that follow a predictable pattern. Distinguishable from suicidal hanging marks because the suicidal suspension ligature mark rises diagonally toward the ear. However, if pressure is applied with a ligature at an upward angle, the mark may be indistinguishable from suicidal hanging marks.
—Scratch mark abrasion: Long, superficial abrasions that may be as wide or narrow as the fingernail itself. Scratch marks may be caused by the assailant or may be a defensive wound caused by the victim trying to remove the hand(s) or object applying pressure to their neck.
—Alternative light source (ALS light): A valuable tool that helps detect the presence of potential forensic evidence (eg, urine, sweat, semen, saliva, vaginal secretions, fibers) and other substances (eg, lotion, oils, powders) that would otherwise remain invisible to the naked eye. The area fluoresces, or glows, allowing samples to be collected; however, the collector cannot confirm the origin of the substance or fiber at the time of collection.2,3
—Anoxia: The absence of oxygen. During strangulation the brain suffers an anoxic injury when the blood supply is completely obstructed.
—Anoxic seizure: Tonic-clonic seizure activity lasting 2 to 8 seconds; results from an anoxic insult to the brain.4
—Asphyxia: A general term which indicating the body is deprived of oxygen. Causes of asphyxia are divided into 4 primary categories: suffocation, strangulation, mechanical asphyxia, and drowning.5,6
—Bruise or contusion: An area of hemorrhage of soft tissue caused by the rupture of blood vessels from blunt trauma. Contusions may be present in skin and internal organs. Some contusions express a pattern. A patterned injury is one which has a distinct pattern that may reproduce the characteristic of the object that caused the injury. The pattern may be caused by the impact of a weapon or other object on the body or by contact of the body with a pattered surface. Deep bruising is typically not visible externally. However, in physical injury, pain over an area without visible hemorrhage is presumed to be bruised/contused. Estimation of the age of contusions based on its color is imprecise and not supported by forensic science evidence.5 However, there is staging of bruising and injury associated with healing stages—hemostasis, inflammation, proliferation, maturation—where bruise staging is possible during microscopic evaluation at autopsy.
—Chin bruise: Occurs when, in an effort to protect the neck, the victim instinctively lowers the head causing the chin to press against the hands of the assailant, and the small vessels are torn and leak to form a bruise.
—Clustering bruises: Usually located on the sides of the neck and on the jawline. May extend onto the chin and collar bones. Consistent with fingers in a hand-grasp strangulation.
—Fingertip bruises: Circular, oval-shaped bruises consistent with the assailant’s grasp.
—Single bruise on neck: Most frequently caused by the assailant’s thumb. Because the thumb generates more pressure than any other finger, this bruise is found more often than fingertip bruises in a hand-grasp strangulation.
—Buccal swabs: Cotton swabs used to collect cheek cells for DNA samples from the inside of the mouth.2
—Choking: Blockage of respiratory passage(s) with a foreign body. Choking results from materials such as food or other objects obstructing the airway and preventing the exchange of oxygen and carbon dioxide.
—Computed tomographic angiography or angiogram (CTA): CTA is used to evaluate the arterial vessels. CTA is the gold standard for the evaluation of the carotid and vertebral arteries for a strangulation-induced dissection. CTA is sensitive for bony, cartilaginous, and soft tissue trauma as well as vascular injuries (Appendix 7).
—Computed tomography (CT): CT is an imaging technique which is fast and provides a detailed view of the internal organs and structures. CT imaging will identify injuries to neck structures (bones and cartilage); however it fails to evaluate injuries to the vasculature of the neck. A CT is not recommended to determine if there are injuries to the carotid or vertebral arteries (Appendix 7).
—Deoxyribonucleic acid (DNA): A valuable piece of biologic forensic evidence. DNA can be transferred between the assailant and the victim during an assault. Swabbing of the victim’s neck, the suspect’s injuries, and other locations is an important component of a strangulation examination.
—Dysphonia: Involves difficulty in speaking because of a physical disorder of the mouth, tongue, throat, or vocal cords.9,10 Spastic dysphonia is a condition of the voice box or larynx, causing the voice to “break.” It is a lifelong condition thought to begin after an upper respiratory infection, injury to the larynx, voice overuse, or stress.11,12
—Dyspnea: Shortness of breath or difficulty breathing.9,13
—ENT: Acronym for “ears, nose, and throat.”14
—Examiner: The term refers to a health care provider conducting a medical forensic examination after trauma. Titles for the role are determined by license, education, and job description in the institution or organization. The term “examiner” has roots in English law and Scotland Yard and is not used by most state licensing boards or educational institutions. For the purposes of this document, the term “examiner” is used for the health care provider. Additional terms used in this document include the “medical forensic provider,” the “sexual assault forensic examiner” (SAFE), the “sexual assault examiner” (SAE), the “forensic nurse,” and the “forensic nurse examiner” (FNE). Many communities refer to the SAE by more specific acronyms and have justification in the specific license, practitioner role, or achievement of specialized education and clinical experiences.15
—Forensic nurse: A registered nurse or advanced practice nurse who has received specific education and training. Forensic nurses provide specialized care for patients who are experiencing acute and long-term health consequences associated with victimization or violence and have unmet evidentiary needs related to being victimized. Forensic nurses also provide consultation and testimony for civil and criminal proceedings. Forensic nursing care is not separate and distinct from other forms of medical care. It is integrated into the overall care needs of individual patients.
—Hypoxia: The deficiency of sufficient oxygen in the blood, tissues, or cells
