Questions for Strangulation Expert Qualifications of Expert: 1. Name 2. Title 3. Current Employer? 4. Current duties? 5. Years employed in your current position? 6. Prior work experience? 7. Education? 8. Medical training? 9. Strangulation Training? 10. Licenses? 11. Certificates? 12. Professional organizations? 13. Teaching experience? 14. Published writings? 15. Previously qualified as an expert witness? 16. How many times? 17. Testified for prosecution? 18. Testified for the defense? 19. Provided expert consultation in cases that did not result in trial? 20. Consult with prosecution?
21. Consult with defense? 22. Examine patients who have reported being strangled and survived? 23. How many have you examined as a treating physician? 24. Are you comfortable testifying today as an expert in the area of strangulation? Questions for expert related to an attempted strangulation case: 1. Define choking: 2. Define strangulation: Strangulation is a form of asphyxia characterized by closure of the blood vessels and air passages of the neck as a result of external pressure on the neck When there is compression of the arteries, oxygen-rich blood does not travel from the heart to the brain. When there is compression of the veins, oxygen-deprived blood cannot travel from the brain to the heart. When there is a combination of both a compression of the arteries and/or veins, we have a major problem as blood is not circulating to and from the brain back to the heart. Where there is compression of the airway, a person cannot breathe. 3. What is the difference between choking and strangulation? Choking is accidentally swallowing an object into one s airway. Strangulation is intentional, but may be accidental, e.g., an infant becoming strangled with a venetian-blinds cord. 4. Describe the methods of strangulation: Manual Ligature Hanging 5. What is hypoxia? Low oxygen in the blood.
6. What happens when there is lack of oxygen to the brain after 10 seconds? 20? 30? 1 minute? 2 minutes? 3 minutes? 4 minutes? 10 seconds or less: no symptoms, or subtle behavioral changes usually harmless and temporary. 10-30 seconds: Variable manifestations, from mild behavioral changes to frank psychiatric disorders, e.g., schizophrenia, delusions, and frank psychosis. PTSD may also occur. Temporary or permanent mental illness (hearing voices, frank psychosis) 30 seconds and more: Temporary or permanent brain damage may occur, and with increasing term of hypoxia, a permanent vegetative state will occur. Ultimately death will occur by complete asphyxia. 7. What is hypoxic encephalopathy? Permanent brain damage from prolonged hypoxia. 8. Define asphyxia: Temporary obstruction of the carotid arteries, or the jugular veins, or the airway will produce HYPOXIA-- an interruption of oxygenation Continuous obstruction of the carotid arteries, jugular veins or airway will produce death by complete loss of oxygen, i.e., ASPHYXIA. Asphyxia can also refer to brain death. 9. What is the difference between hypoxia and asphyxia? Hypoxia does not imply death but may refer to permanent brain damage. Asphyxia may refer to death and is the severest form of hypoxia. 10. What happens to the brain when there is asphyxia or an interruption of oxygenation? It depends upon n the length of obstruction. Within seconds there can be unconsciousness. Within seconds to a few minutes there can be temporary or permanent brain injury. Within four minutes or less there may be brain death. 11. Can the lack of oxygen to the brain result in either temporary or permanent brain injury?
Yes 12. Other than unconsciousness, are there other signs of temporary hypoxia or asphyxia? Behavioral changes. 13. What do you mean by behavioral changes? Inappropriate, Irrational or combative behavior. 14. How much external pressure and time does it take to cause unconsciousness? Carotid Arteries, 11 pounds for 10 seconds. Jugular Veins, 4.4 pounds for 10 seconds Airway, 33 pounds for 10 seconds. But it can vary. 15. What are some the variables? Age and size of the victim Age and size of the defendant. Underlying chronic illnesses, e.g., hardening of the arteries, diabetes, etc. Alcohol Intoxication Drug abuse Use of a ligature and the type of the ligature Vulnerability of the victim Ability or inability to defend oneself Method of strangulation (hands, feet, object) Sitting on the chest Complete compression of arteries and/or veins will take less time to cause unconsciousness Partial compression of the arteries and/or veins will take longer 16. What are the signs or symptoms of unconsciousness? Amnesia Standing up one minute and finding oneself on the floor the next Seeing stars An unexplained new bump to the head from an apparent injury, with no memory of the Precipitating event. 17. How long does it take a strangled victim to regain consciousness after unconsciousness? It varies; it could be within 10 seconds or longer.
18. What are the variables? Repeated strangulation Alcohol or drug Intoxication Age of the victim Underlying health problems. However, there may be a point of no return. 19. Please explain the point of no return that occurs after 50 seconds of continuous strangulation, with a complete disruption of oxygen supply to the brain: After approximately fifty seconds of a continuous, unrelenting strangle hold, with complete obstruction of either the carotid arteries, jugular veins or trachea (or all three), the chances that a victim will regain consciousness if the strangle hold is released become remote. 20. How much external pressure must be applied before death occurs? Generally, four minutes or less of continuous pressure will cause death. However the number of minutes to cause death may vary from person to person, based upon several factors 21. What are some of the variables? Age of the assailant and of the victim. Alcohol Intoxication Concurrent drug use Use of a ligature and the type of the ligature Vulnerability of the victim Ability to defend oneself Manual strangulation and method Complete compression of arteries and/or veins will take less time Partial or intermittent compression of the arteries and/or veins will take longer 22. Aside from unconsciousness, or behavioral disorders, are there other signs and symptoms of having been strangled? 23. Would a chart or charts help you explain those signs and symptoms? Yes. 24. Did you bring any with you today or may I direct to you to: EXHIBIT: Anatomy chart to show arteries, veins, muscles, cartilage EXHIBIT: Signs & symptoms chart
25. Please describe the external signs of attempted strangulation? There may be visible external marks such as redness, bruising, scratch marks, impression marks, claw marks. Petechiae Swelling of the neck or tongue 26. Where would you find visible findings such are redness, scratch marks, impression marks, or claw marks? Face, neck, chest, back, mouth, behind the ears 27. Describe how Petechiae are formed. Tiny blood vessels known as capillaries bursting under the pressure of backflow of blood accumulating in the brain 28. Where can petechiae be seen on victims after strangulation has occurred? Anywhere along the path of the vein and/or artery Only above the point of external pressure face neck eyes eyelids scalp inside the ear behind the ear inside the mouth tongue inner throat 20. What do petechiae look like? Small red spot or multiple spots Cover the whites of the eye Cover the face - Florid Smooth and flat 21. How long do they last? It varies, sometimes days, weeks but rarely months.
22. Are there other causes for petechiae other than strangulation? Yes 23. What? Severe coughing Difficult childbirth Scuba diving Sky diving Some severe Illnesses, e.g., bacterial meningitis. 24. How are these petechiae different from the ones seen in strangulation? They are not necessarily exclusive to the head and neck, only, as is seen in strangulation. 25. Why could there be swelling to the neck from strangulation? Internal swelling from compression and manipulation of the tissues Cracks or breaks in the laryngeal cartilage ( Adam s Apple ), or in the tracheal rings, may cause air to escape into the tissues of the neck. This is known as subcutaneous emphysema. Internal bleeding into the tissues of the neck causing swelling from hemorrhage. 26. Are there other internal injuries associated with strangulation or hypoxia? Aspiration pnuemonitis Pneumonia Stroke Heart attack 27. Why would the tongue swell? Answer: blood backs up into the tongue because it cannot drain out, as the strangle hold on the neck is compressing the jugular veins. Also, it may swell because it was severely bitten because the strangulation precipitated a seizure and tongue-biting frequently accompanies seizures. 28. What are some of the symptoms of attempted strangulation? Voice changes Swallowing changes Vomiting
Urination Defecation Head rush 29. Why voice changes? Damage to the nerves of the vocal cords Injury to the cartilage of the larynx Swelling around the vocal cords 30. Why swallowing changes? Injury and swelling to the to the muscles of the neck Injury and swelling to the esophagus and/or the tissues around the esophagus Injury and swelling to the tissues of the airway cartilages. 31. Why nausea or vomiting? Severe terror Swallowing blood from a broken nose or a cut in the mouth or tongue Gulping of air during an altercation and violent strangulation will inflate the stomach 32. Why urination or defecation? When there has been a loss of oxygen to the portions of the brain that control vegetative functions, the brain can no longer keep the sphincter muscles of the bowel or bladder on autopilot and urinary or bowel incontinence results When someone defecates and/or urinates, they may be close to death. Because the portion of the brain that controls these functions is the last to be affected by loss of oxygen. 33. What if a victim didn t urinate or defecate, but felt like s/he were going to? Answer: Profound terror of the impending loss of life 34. Can the signs of a victim who survives strangulation be similar to the signs on a victim who has died as a result of strangulation? Yes 35. Is there a way to tell how close a strangulation victim has come to death? The greater the number of signs and symptoms that a victim has, in general the closer s/he came
to potentially dying. 36. How do you know when strangulation is serious? Any external pressure to neck that compresses the arteries and/or veins for more than 10 seconds is serious, especially if there are complicating factors. 37. What information and/or documents did you review in this case prior to testifying? Police report? 911 tape? Medical report? Paramedic records? Interview with the victim? Examine patient? Photographs? Videotapes of the victim? Audiotapes of the victim s interview? 38. From your review, what were the signs and symptoms that the victim exhibited? 39. In your opinion, are those signs and symptoms consistent with someone who has been strangled? 40. Is it your opinion that the application of force to the victim s neck for * seconds could cause internal injury? 41. Is it your opinion that the victim suffered internal injury? Serious injury? Potentially great bodily injury? Below are questions for you may consider asking in a homicide by strangulation case (courtesy of San Diego County Deputy District Attorney Dan Goldstein): 1. Are you a medical examiner? 2. How long have you been a medical examiner? 3. What specific training goes into becoming a medical examiner? 4. What are your duties? 5. What is an autopsy? 6. How many autopsies have you conducted in your career?
7. Have you testified in court? 8. What is a witnessing pathologist? 9. Were you the witnessing pathologist on *** during an autopsy of the victim? 10. Who was the pathologist? 11. Did you review the pathologist s report? 12. Please describe the external trauma of the victim that you saw. 13. Ask the witness to describe photos and injuries. 14. Ask the witness to describe any injuries to the eyes, face, and mouth. 15. Ask the witness to describe internal injuries. 16. What was the cause of death? 17. What are the reasons you believe the victim died from strangulation?