Strangulation Pitch

Strangulation Pitch

The role and benets of the medical forensic work in the approach of family violence and lessons learned about strangulation Dr Catherine White 1st December 2017 Dr Catherine White EFJC 1st December 2017 2

1986 24,000+ clients All ages Male & female

Self and police referrals Opened Childrens SARC in 2006 530 Children in 2016/2017 924 Adults in 2016/2017 Population of 3.4 million Dr Catherine White EFJC 1st December 2017 3 St Marys SARC Child/Adult Referrals 2016/17 1454

530; 36.45% 924; 63.55% Dr Catherine White EFJC 1st December 2017 Adult Child 4 Child Age Range 2016/17 Under 12 years

248; 46.79% 13-17 years 282; 53.21% Dr Catherine White EFJC 1st December 2017 5

Risk assessment during the examination Forensic Safeguarding Medical Dr Catherine White March 2016 Forensic Dr Catherine White EFJC 1st December 2017

9 Non-Fatal Strangulation It is dangerous! Signs and symptoms Management Dr Catherine White EFJC 1st December 2017 10

NFS an important risk factor for homicide of women Nancy Glass J Emerg Med 2008 35(3) A History of NFS: X 6 times risk of becoming a victim of attempted homicide X 7 times risk of becoming a completed homicide Dr Catherine White EFJC 1st December 2017

11 Femicide Census Strangulation; 24.89% Other; 75.11% Dr Catherine White EFJC 1st December Strangulation2017Other 12

Strangulation Obstruction of blood vessels and/ or airflow in the neck resulting in asphyxia. Dr Catherine White EFJC 1st December 2017 13 Choke Mechanical obstruction

Dr Catherine White EFJC 1st December 2017 14 Anoxia Absence of oxygen Hypoxia Decreased oxygen Dr Catherine White EFJC 1st December 2017

15 Dr Catherine White EFJC 1st December 2017 16 Carotid artery compression Dr Catherine White EFJC 1st December 2017 17

Carotid artery compression No blood flow to the brain Dr Catherine White EFJC 1st December 2017 18 Carotid artery compression No blood flow to the brain Compression +/- fracture of larynx or trachea

Dr Catherine White EFJC 1st December 2017 19 Carotid artery compression No blood flow to the brain Compression +/- fracture of larynx or trachea No oxygen intake Dr Catherine White EFJC 1st December

2017 20 Carotid artery compression No blood flow to the brain Compression +/- fracture of larynx or trachea No oxygen intake Jugular vein compression Dr Catherine White EFJC 1st December

2017 21 Carotid artery compression No blood flow to the brain Compression +/- fracture of larynx or trachea No oxygen intake Jugular vein compression Stagnant hypoxia

Dr Catherine White EFJC 1st December 2017 22 Carotid artery compression No blood flow to the brain Compression +/- fracture of larynx or trachea No oxygen intake Jugular vein Stagnant hypoxia

Pressure on carotid bodies and baroreceptors Dr Catherine White EFJC 1st December 2017 23 Carotid artery compression No blood flow to the brain Compression +/- fracture of larynx or trachea No oxygen intake

Jugular vein Stagnant hypoxia Pressure on carotid bodies and baroreceptors Bradycardia / asystole Dr Catherine White EFJC 1st December 2017 24 Pressure on the neck

Jugular vein Carotid artery Trachea 4psi, 11psi, 34 psi. Dr Catherine White EFJC 1st December 2017 25

Pressure on the neck Jugular vein Carotid artery Trachea 4psi, 11psi, 34 psi. Opening a can of coke 20psi Adult male hand shake 80-100psi Dr Catherine White EFJC 1st December

2017 26 The timeline 6.8 seconds LOC 15 seconds Bladder incontinence

30 seconds Bowel incontinence 2-3 minutes Cell death 4-5 minutes Brain death

Dr Catherine White EFJC 1st December 2017 27 http://www.youtube.com/watch?v=AgbwP6Hn-l M&sns=em Dr Catherine White EFJC 1st December 2017 28

Symptoms None Dr Catherine White EFJC 1st December 2017 29 We didnt ask They have already told someone & assumed information would be shared. They did but we didnt hear. They are confused.

Dr Catherine White EFJC 1st December 2017 30 Dr Catherine White EFJC 1st December 2017 31 Dr Catherine White EFJC 1st December 2017

32 No oxygen = no memory Dr Catherine White EFJC 1st December 2017 33 St Marys NFS Checklist & Proforma Dr Catherine White EFJC 1st December 2017

34 St Marys Multi-agency NFS Working Group Police CPS

ENT & Radiology Forensic Pathologist National Injuries Database Dr Catherine White EFJC 1st December 2017 35 Management Pathway Dr Catherine White EFJC 1st December 2017

36 St Marys SARC NFS June 2016-November 2017 99 cases Complainants 95 female 4 male Suspects all male Dr Catherine White EFJC 1st December 2017 37

Gender of complainants n=99 Female Male 4.04% 95.96% Dr Catherine White EFJC 1st December 2017 38

Suspect Type N=99 12.94% 4.71% Partner / ex-partner Stranger 12.94% Acquaintance Friend

54.12% Unknown 15.29% Dr Catherine White EFJC 1st December 2017 39 Age in years of Complainants N=99 35

29 30 26 25 20 15 10 13 7

11 6 4 5 0 2 2

Age in years of complainant under 18 38-42 18-22 42-47 23-27 48-52 28-32 >53

Dr Catherine White EFJC 1st December 2017 33-37 40 Actions of Complainant in handcuffs so unable to move "learnt from previous episodes just to keep very still Does not ght back as increased pressure. Says "Just do it, kill me I've had enough "went floppy, tried to keep still More she struggled and complained harder he gripped so she stopped saying

anything stayed very still Cooperated fully as afraid Froze Dr Catherine White EFJC 1st December 2017 41 Injuries noted at FME Injuries noted

Tenderness only None Not recorded 3.85% 35.90% 43.59% 16.67% Dr Catherine White EFJC 1st December 2017

42 Loss of consciousness 10% Dr Catherine White EFJC 1st December 2017 43 Deidre

Dr Catherine White EFJC 1st December 2017 44 NFS + sexual assault NFS but no sexual assault Specialist secure victim focussed centre

Forensic clinician assessment Crisis worker

Colposcopic images Forensic samples

ENT Radiology pathway Forensic report

Shower & clothing Expert report

Advocacy Quality assurance & peer review Dr Catherine White EFJC 1st December 2017

45 Adverse Childhood Experiences Felitti VJ, Anda RF, Nordenberg D et al. 1998. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine 14:245258.

4+ ACEs compared to no ACEs IHD 2.2 COPD 3.9 Stroke 2.4 Any cancer 1.9 Ever attempted suicide 12.2 THE LONG REACH OF CHILDHOOD TRAUMA BY ARIELLE LEVIN BECKER

Remote Live Court Room Link Suite Dr Catherine White EFJC 1st December 2017 50 THANKYOU [email protected] [email protected] www.stmaryscentre.org

@StmarysSARC @catherinewhite7 Dr Catherine White EFJC 1st December 2017 51

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