this form of trauma, other vulnerable populations cannot be overlooked by health care and law enforcement professionals, including children and the elderly. Professionals providing a response to these vulnerable groups should also consider that these patients may have been injured by forms of smothering or suffocation.
In 44 states and the District of Columbia, health care professionals are obligated to report elder abuse to adult protective services.4 Elder abuse is defined as an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult. (An older adult is defined as someone age 60 or older.) Forms of elder abuse are recognized to include physical abuse, sexual abuse or abusive sexual contact, emotional or psychological abuse, neglect, and financial abuse or exploitation.5
The incidence of strangulation and subtle nature of associated symptoms and injury are not easily distinguished if health care professionals, law enforcement, and pre-hospital personnel are not exposed to education and training about identification, screening, assessment, and treatment. In addition, forensic nurses have a pivotal role in not only evaluating patients seen after strangulation, but providing in depth evidentiary examinations and accurate medical-forensic documentation. A variety of case studies, best practice recommendations, and tools to support evaluation and documentation are reviewed in the following chapters.
Diana K. Faugno, MSN, RN, CPN, SANE-A SANE-P, FAAFS, DF-IAFN, DF-AFN
Valerie Sievers, MSN, RN, CNS, SANE-A, SANE-P, DF-AFN
Michelle Shores, MSN, RN, MBA-HC, CEN, SANE-A, SANE-P
Bill Smock, MD
Patricia M. Speck, DNSc, CRNP, FNP-BC, DF-IAFN, FAAFS, DF-AFN, FAAN
1.Breiding MJ, Basile KC, Smith SG, Black MC, Mahendra RR. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 2.0. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2015.
2.Strack GB, McClane, GE, Hawley, D. A review of 300 attempted strangulation cases part I: criminal legal issues. J Emerg Med. 2001;21(3):303-309.
3.McClane, GE, Strack, GB, Hawley, D. A review of 300 attempted strangulation cases part II: clinical evaluation ofthe surviving victim. J Emerg Med. 2001;21(3):311-315.
4.Daly JM, Jogerst GJ. Statute definitions of elder abuse. J Elder Abuse Negl. 2003;13(4):39-57.
5.Hall, JE, Karch, DL, Crosby, AE. Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements for Use in Elder Abuse Surveillance, Version 1.0. Atlanta (GA): National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2016.
REVIEWS
Domestic Violence and Nonfatal Strangulation Assessment is a valuable tool to educate first responders, SAFE/SANE nurses, and medical providers on how to assess, document, and treat victims of nonfatal strangulation. It starts by standardizing basic definitions and moves on to discuss the anatomy, signs and symptoms, and injuries seen in victims of strangulation. Information on the various imaging modalities and what each specific technique visualizes is provided. The multiple case studies, along with the resources in the appendices and the recommended readings, serve to standardize our documentation. This book provides invaluable, evidence-based information to both novice providers and experienced providers alike.
Rosalyn Berkowitz, BSN, RN, FNE A/P
Forensic Nurse Examiner
SAFE and Domestic Violence Program
Greater Baltimore Medical Center
Towson, Maryland
Strangulation victims most often do not have signs or symptoms of strangulation. The Domestic Violence and Nonfatal Strangulation Assessment is very important to implement in every health care provider’s practice. This guide does a great job presenting case studies from everyday practice and gives you the knowledge you will need to assess the strangulation victim while using the best evidence-based practices and tools. Photos are used to discuss the anatomic location of common injuries and proper documentation of those injuries. Safety and proper discharge planning are essential in these patients and are discussed in the guide with great resource recommendations for the victims. Overall, this an excellent guide from a very knowledgeable group of expert authors.
Natalie Calow, MSN, RN, CEN
Forensic Nurse IUH Methodist Hospital
Indianapolis, Indiana
The case studies used in this comprehensive guide can be extremely helpful for newer forensic nurses or for those working in rural areas that may not have seen the volume of forensic examinations a busier metropolitan area has. The pictures and activities at the end of each chapter will help prepare these nurses for the injuries they might see during a strangulation examination.
Kristin Hall, BSN, RN, CEN
Clinical Director
Family Justice Center SANE
The Domestic Violence and Nonfatal Strangulation Assessment for Health Care Providers and First Responders will be a tremendous asset for those that encounter a victim of strangulation. Often, first responders may not be trained on the signs and symptoms of a strangulation assault and may overlook some important information and assessments. The use of case studies and imaging in this guidebook will assist first responders and health care providers in recognizing some of the physical signs that may be present, but also the verbal identifiers the victim may report. This guide will provide a quick and easily accessible reference to understand the uniqueness of this form of violence and provide the necessary steps to provide the best practice initial care and compassion these individuals will need upon first contact with health care or law enforcement.
Lori Combs, BS, RN, LNC
Forensic Nurse Expert/Forensic
Consultant
Critical Analysis Consulting RN
Fort Myers/Cape Coral, Florida
Domestic Violence and Nonfatal Strangulation Assessment for Health Care Providers and First Responders is a collection of case studies that presents relevant discussions and activities to enhance the user’s knowledge base surrounding nonfatal strangulation. Leaders in the field have compiled pertinent case studies, including photographs, which promote discussion of the challenges surrounding nonfatal strangulation cases and provide best practice recommendations for these cases. We keep this workbook in our “library.” It is used as a teaching aid and reference for SANEs.
Each case study provides an anatomic skill review that reinforces areas of interest or concern when caring for victims of nonfatal strangulation. An injury identification activity for each case study provides visual cues for photodocumentation and can bolster the provider’s documentation skills by incorporating key descriptive words to use when describing findings. Case studies also provide activities to enhance the user’s assessment and evidence collection skills. Activities are designed to encourage the user to outline appropriate care and referrals for each patient.
Jennifer
