Fire & Emergency Medical Technician Training


Domestic Violence and Strangulation Training for Firefighters and EMTs

Domestic Violence in the Streets: The Incident, the Victim, and the Abuser


Problem Statement: 1 in 3 women and 1 in 4 men have experienced some form of physical violence by an intimate partner in their lifetime[i].  “Our study proved it – most victims of strangulation will not have visible external injuries. The lack of visible injuries and the lack of training caused the criminal justice system to minimize strangulation. We failed victims. But now we know – strangulation has serious, immediate and long-term health consequences.” Gael Strack, Esq., CEO of Training Institute on Strangulation Prevention.

Currently in Ohio, strangulation is not a felony. “Women at high risk, up to 68 percent will experience near-fatal strangulation by their partner. Loss of consciousness can occur within 5 to 10 minutes; death within minutes.”  “Only half of victims have visible injuries, and of these, only 15 percent could be photographed.” The most common visible injuries are neck bruising and so-called “petechiae spots,” which show up on the face, scalp, mouth, earlobes, eyelids, and eyeballs of choked victims. Choking also causes damage to the victim’s throat, making breathing, swallowing, coughing, and talking difficult. Infrared forensic cameras can document the tissue damage in the throat.  Death can occur days or weeks after the attack due to carotid artery dissection and respiratory complications such as pneumonia, acute respiratory distress syndrome (ARDS), and the risk of blood clots traveling to the brain (embolization).[ii]

Medical training for the identification of domestic violence injuries, including strangulation, is often overlooked, and not included in core training. Statistics show a link between domestic violence/strangulation and mass killers.  “Research has now made clear that when a man puts his hands around a woman, he has just raised his hand and said, “I’m a killer.” They are more likely to kill police officers, to kill children, and to later kill their partners. So, when you hear “He choked me”, now we know you are the edge of a homicide.” – Casey Gwinn, Esq., President of Alliance for HOPE International and Co-Director of Training Institute on Strangulation Prevention.  It is crucial for Law Enforcement Officers to understand the link between strangulation and murderers.


Project Description:  Our training program provides local first responders with an in depth look at domestic violence and strangulation.  It looks at the domestic violence incident, a conditioned victim, and a malignant narcissist. We provide first responders with the potential dangers that come with the domestic violence scene.  The training provides a close look at a local strangulation case study, her long-term consequences, and her personal testimony.  We discuss prehospital medical assessments, treatments, and key documentation components. We give first responders a look at the legal system and what to expect from the responding officer, prosecutor, and detective.  We provide attendees with a real life look at local and state policies regarding strangulation and domestic violence.   The best way for first responders to be a voice for their patient is to better understand the dynamics of domestic violence and strangulation.  This program gives them that.


Goals and Objectives: 

  • That attendees can immediately recognize signs of strangulation and be more alert for the non-visible signs/symptoms.
  • That in our 1 year follow up every attendee can report that they have used the information we have provided in each domestic violence call they became a part of.
  • That on each domestic violence call, attendees are better equipped to immediately recognize the potential scene safety concerns for victims, themselves, and community members.
  • That attendees can recognize the conditioned victim and to better understand different ways to provide support and treatment.
  • That first responders are more understanding of the malignant narcissist and the concerns they bring for their safety as well as the victims.
  • That attendees have a better understanding of domestic violence incidents, abusers, and victims and confidently handle them.
  • That attendees can confidently document a domestic abuse and/or strangulation case.

[i] Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M. (2011). The national intimate partner and sexual violence survey: 2010 summary report.  Retrieved from

[ii] Dr. Steve Albrecht Psychology Today © 1991-2017 Sussex Publishers, LLC | © 2002-2017 Sussex Directories, Inc.


Follow the link below for a printable copy of our Domestic Violence Training for Fire and EMS flyer:
DV EMS & Fire training flyer