EvidenceJusticeLuke Wirkkala

Strangulation Expert: Strangulation Assessments Are a Must

By November 16, 2020January 7th, 2021No Comments

Written by Heather Brand, an expert witness on strangulation. This article makes it clear why the Deschutes County prosecutor Mary Anderson was socially and morally irresponsible when she downplayed the strangulation of Luke Wirkkala by David Ryder as “rough sex”. The Deschutes County prosecutor Mary Anderson also lied to the court, citing that Luke never touched his neck during the 14 hours in police custody, the prosecution’s “evidence” that it wasn’t a serious injury or threat to his life. Footage of the police questioning, revealed only after Luke was sentenced to life in prison, showed that Luke touched and gestured to his neck between 8 and 11 times, including grimacing in pain.

By Heather Brand, MPH, MSN, APRN, WHNP-BC, SANE -A

Strangulation is one of the most lethal forms of intimate partner violence. By either blocking off the carotid arteries, blocking off the jugular veins, closing off the airway, or a combination of the three, the oxygen supply to the brain is compromised, causing brain cell death by asphyxiation. While strangulation can cause death within 10 to 15 seconds and up to four minutes, delayed death can occur hours, days, and even weeks after a strangulation due to the slow progression of internal injuries and the lack of injury recognition by victims and medical professionals.

In a 2001 review of 300 strangulation cases by Strack et al., researchers found that half of the victims did not have any visible injuries. First responders and patients alike often underestimate the severity of injury when there is a lack of external injury. However, the presence or absence of visible external injury is not a reliable predictor of injury severity. Symptoms reported by the victim such as loss of consciousness, difficulty breathing, painful swallowing, sore throat, loss of bowel or bladder control, and other symptoms indicating artery or airway occlusion and nerve damage are better indicators for internal injury severity and the necessity for further medical evaluation, imaging studies, and monitoring.

Reported symptoms may indicate internal injuries such as carotid artery dissection, neck soft-tissue swelling, aspiration pneumonia, subcutaneous emphysema, pulmonary edema, and other injuries to structures in the neck that require immediate medical intervention to prevent death and disability. Pregnant women may be at risk of miscarriage and should receive fetal heart monitoring. Brain cell death caused by asphyxiation during the strangulation can lead to short-term or permanent psychiatric changes in the victim such as memory loss, hostility or aggressiveness, depression, insomnia, anxiety, and suicidal ideation, requiring psychiatric care and follow-up. Victims who survive a strangulation incident are at a six-fold increased risk of becoming an attempted homicide, and at a seven-fold increased risk of becoming a completed homicide. Medical evaluation for strangulation victims in not only a medical necessity for the victim’s immediate well being, but also a necessity for their future survival.  


  1. Hawley, Dean A. (2013). Death by strangulation or suffocation. The Investigation and Prosecution of Strangulation Cases, Chapter6:63-80.
  2.  Mclane, George E.; Strack, Gael B.; Hawley, Dean A. (2001). A Review of 300 attempted strangulation cases part II: clinical evaluation of the surviving victim. The Journal of Emergency Medicine, 21(3), 311-315.
  3.  Strack, Gael B.; McClane, George E.; Hawley, Dean A. (2001). A Review of 300 attempted strangulation cases part I: criminal legal issues. The Journal of Emergency Medicine, 21 (3), 303-309.
  4.  Shields, Lisa B.E.; Corey, Tracey S.; Weakley-Jones, Barbara; Stewart, Donna. (2010). Living victims of strangulation: a 10-year review of cases in a metropolitan community. The American Journal of Forensic Medicine and Pathology, 31, 320-325.
  5.  Christe, Andreas; Thoeny, Harriet; Ross, Steffen; Spendlove, Danny; Tshering, Dechen; Bolliger, Stephan; Grabherr, Silke; Thali, Michael J.; Vock, Peter; Oesterhelweg, Lars. (2009). Life-threatening versus non life-threatening manual strangulation: are there appropriate criteria for MR imaging of the neck?. European Radiology, 19, 1882-1889.
  6.  Hawley, Dean A. (2013). Death by strangulation or suffocation. The Investigation and Prosecution of Strangulation Cases, Chapter 6:63-80.
  7.  Funk, Maureen; Schuppel, Julie. (2003). Strangulation injuries. Wisconsin Medical Journal, 102 (3), 41-45. 

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