Domestic Violence and Nonfatal Strangulation Assessment

Domestic Violence and Nonfatal Strangulation Assessment serves to instruct readers on the language of evidence-based evaluative methods of care for victims of strangulation at the hands of an intimate partner or family member.

E-pub available on Kindle and iBooks

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Domestic Violence and Nonfatal Strangulation Assessment
for Health Care Providers and First Responders

Forensic Learning Series

Domestic Violence and Nonfatal Strangulation Assessment is designed to teach readers the language and basics of evaluative methods for strangulation patients in the context of domestic violence. Fifteen case studies with a detailed history and photographs are included to provide readers with a greater understanding of the various types of strangulation situations they may encounter in the future. In addition to discussions about identifying injuries, chapters also focus on evidence-based forensic collection techniques and treatment based on current best practices.

The appendix includes common practice recommendations and other tools to support evaluation and documentation, such as a petechial hemorrhage challenge, information on Danger and Lethality assessments, and charts detailing care for pregnant victims. This workbook will help fulfill the reader’s need for basic, peer-reviewed information and will contribute to continuing competence in care for strangulation patients.

Features & Benefits:

  • Over 200 high-quality images
  • 15 case histories with corresponding exercises
  • Ideal for self-directed study or group instruction
  • Authored by internationally recognized experts
  • Written for medical professionals at every level of experience, from novice to advanced

STM Learning’s editorial team has also developed a set of flashcards on nonfatal strangulation and domestic violence to accompany the text.

Product Details:

Perfect Bound 11×8.5 inches
218 pages, 201 images, 12 contributors


Forensic Nurses, Sexual Assault Nurse Examiners, Sexual Assault Forensic Examiners, Emergency Nurses, Nurse Practitioners, Nursing Students, Physicians, Emergency Physicians, Medical Students, Physician Assistants, Victim Advocates.

Publication date:

August 2020


978-1-936590-83-4 (Print)

978-1-936590-84-1 (eBook)

Table of Contents


Section I: Definitions and Anatomic Review

Section II: Case Study Chapters
1. 32-Year-Old Female Strangulation Patient with Hyoid Bone Fracture and Suicidal Ideation
2. 21-Year-Old Male Patient Assaulted by an Acquaintance
3. 66-Year-Old Female Patient Assaulted by Her Son
4. 17-Year-Old Female Patient Assaulted by an Acquaintance
5. 26-Year-Old Female Patient Assaulted by a Former Intimate Partner
6. 15-Year-Old Female Patient Assaulted by a Stranger
7. 24-Year-Old Female Patient Assaulted by a Former Intimate Partner
8. 65-Year-Old Female Patient Assaulted by a Former Intimate Partner
9. 31-Year-Old Female Patient Assaulted by a Former Intimate Partner
10. 22-Year-Old Female Patient Assaulted by a Former Intimate Partner
11. 70-Year-Old Male Patient Assaulted by an Employee
12. 56-Year-Old Female Patient Assaulted by an Ex-Husband
13. 30-Year-Old Female Patient Assaulted and Strangled by an Intimate Partner
14. 25-Year-Old Female Patient Assaulted by a Stranger
15. 46-Year-old Female Patient Assaulted and Strangled by her Husband

Section III: Appendix

Section IV: Recommended Reading

Section V: Answer Key


Diana Faugno, a Minnesota native, graduated from the University of North Dakota in 1973 with a degree in nursing and obtained an MSN in 2006. Her professional experience includes nursing in the Medical/Surgical, Labor and Delivery, Pediatrics, and Neonatal Intensive Care departments. Ms. Faugno obtained her certification in pediatric nursing in 1990, began a career as a sexual assault nurse examiner in 1991, and became a certified sexual assault nurse examiner in 2002. She is the former director of Forensic Health Services, which includes a child abuse program, sexual assault team, and a family violence program in North San Diego County. Currently, Ms. Faugno is a board director for End Violence Against Women International. She has made several presentations to the scientific community and has led workshops on sexual assault presented at the American Academy of Science.

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Valerie Sievers, MSN, RN, CNS, SANE-A, SANE-P, DF-AFN

Val Sievers is a Forensic Clinical Nurse Specialist with more than 35 years of health care experience as a registered nurse, advanced practice nurse, educator and consultant with extensive practice experience in the arenas of emergency and critical care nursing, academic education and forensic clinical practice.
As a Clinical Nurse Specialist, Val provides advanced education regarding the care and treatment of patients affected by violence and abuse. She is currently dual board certified as an adult-adolescent and pediatric sexual assault nurse examiner, owner of MedLaw Consultants, LLC; a forensic healthcare consulting practice and is a board member of the Academy of Forensic Nursing.

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Michelle Shores, RN, MSN, MBA-HC, CEN, SANE-A, SANE-P

Michelle Shores is a forensic nurse examiner and the Program Director for Palomar Health Forensic Services in San Diego County, and on occasion she works as a forensic nurse in Riverside County for Forensic Nurses of SoCal. The Forensic Health Services program in San Diego is a nationally accredited child advocacy center that provides acute care services to victims of sexual assault and domestic violence. Michelle is 1 of 19 certified pediatric sexual assault nurses and 1 of 50 certified adolescent/adult sexual assault nurse examiners in the state of California.  Michelle has recently implemented a pilot program through a county grant at Forensic Health Services to perform 688 forensic medical evidentiary exams for victims of domestic violence, strangulation, general assault, and elder abuse and assisted in developing the San Diego heath CARES initiative.

Michelle graduated with her bachelor’s degree in nursing in 2005 and began working as an emergency department trauma nurse in 2006. In 2012 Michelle earned master’s degrees in nursing and in business. Michelle was a clinical nursing instructor, is a certified emergency nurse, International Association of Forensic Nurse Board certified SANE-A (adolescent/adult) and SANE-P (pediatrics) and a certified trauma nurse instructor (TNCC). She has been a long standing member of the International Association for Forensic Nursing and is vice president for the southern California chapter, a member of the Academy of Forensic Nursing,  and has worked as a forensic nurse for over seven years. She is the 2017 winner on the San Diego County SART with a HEART Award, the 2018 Riverside County SART Nurse of the Year award, the 2018 San Diego Domestic Violence Council Lifetime Achievement award, and the November 2018 CARE award that recognized her as a leader in the community and excellence as a forensic nurse examiner.

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Bill Smock, MD, MS

Bill Smock is a full-time Police Surgeon and directs the Clinical Forensic Medicine Program for the Louisville Metro Police Department in Louisville, Kentucky. Bill graduated from the University of Louisville, School of Medicine in 1990 and completed a residency in emergency medicine at the University of Louisville in 1993. In 1994, he became the first physician in the United States to complete a post-graduate fellowship in Clinical Forensic Medicine. Dr. Smock served as Assistant Medical Examiner with the Kentucky Medical Examiner’s Office from 1991 to 1997 and the Medical Advisor to the Louisville Division of the FBI from 2003 to 2013. Dr. Smock joined the Louisville Police Department in 1993 as the SWAT team’s first tactical physician, a position he has held for the last 27 years. Dr. Smock is currently a Clinical Professor of Emergency Medicine at the University of Louisville School of Medicine training medical students and resident physicians in tactical medicine and clinical forensic medicine. In 2019 Dr. Smock was named the Medical Director of the San Diego-based Training Institute on Strangulation Prevention.

Dr. Smock has edited three textbooks on clinical forensic medicine and published more than 40 chapters and articles on forensic and emergency medicine. He is an internationally recognized forensic expert and trains nurses, physicians, law enforcement officers, attorneys and judges in multiple fields including: reconstruction of officer-involved shootings, the investigation and prosecution of fatal and nonfatal strangulation, gunshot wound interpretation, staged crime scenes, injury mechanisms and motor vehicle trauma. Dr. Smock is also the Police Surgeon for the Floyd County (Indiana) Sheriff’s Office, the New Albany (Indiana) Police Department, the Jeffersontown (Kentucky) Police Department and the St. Matthews (Kentucky)

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Patricia Speck is an internationally recognized family nurse practitioner who specializes in public health and forensic nursing. She graduated from the University of Tennessee Health Science Center, College of Nursing and later completed her doctoral dissertation on sexual assault program evaluation. As a board certified family nurse practitioner, Patricia’s clinical practice focuses on the health aftermath of violence and her research centers on forensic nursing practice topics. She is a consultant, author, and lecturer on forensic nursing and has earned more than 20 local, national, and international awards and professional honors for her work. Patricia chairs the American Public Health Association’s Family Violence Forum and is a former president of the International Association of Forensic Nurses.

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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 Knowlton, RN, SANE-A
Chief Executive Officer
Chesapeake Forensic Specialists
Chesapeake, Virginia

This workbook lays the foundation of fundamental concepts necessary for evidence-based clinical and medical-forensic assessment and care of the strangulation patient. It addresses key information that underlies the background and dynamics of domestic violence and applies it toward a holistic care approach. Each case study looks at the unique medical and psychosocial implications. A literature-based discussion is provided, which drives clinical decision making, safety planning, and mental and behavioral health guidance. Health care providers can rely on this resource to enhance their care plans to meet the comprehensive set of needs of the strangulation patient.

Amber O’Malley, MSN, RN, SANE-A, SANE-P
Forensic Nurse Examiner
NWA Forensic Nurses
Bentonville, Arkansas

The Domestic Violence and Nonfatal Strangulation Assessment is an outstanding guide for those who provide care to victims of domestic and intimate partner violence affected by strangulation. This workbook is all-encompassing and addresses the physical, mental, emotional, social, and legal challenges victims and providers experience when providing care to those impacted by violence. It highlights evidence-based practice screening tools, diagnostic testing, assessment pearls, evidence collection, and resources, enhancing a provider’s ability to deliver safe, quality, comprehensive medical-forensic treatment and care. This workbook is not only a must-read for forensic nurses, but for all health care providers.

Jennifer Barrett, MSN, RN, CNS, SANE-A, SANE-P
Sexual Assault Nurse Examiner,
Forensic Clinical Nurse Specialist
Denver Health Medical Center
Denver, Colorado

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