Crime and domestic violence occupies a part of life, no matter how ferociously it is fought, and no matter how much people wish it wasn’t there. It is important to have good guys that give a voice to the victims; who let hopeless victims know that they can get justice.
In 2019, the Kentucky Legislature passed a law making strangulation a felony. Kentucky was one of the last three states in the nation who had not taken steps to outlaw the practice. Previously strangulation was a misdemeanor, and it seemed to lawmakers that it was nothing more than a slap on the wrist.
Due to the new law, Kentucky officials wanted to have a comprehensive prosecution manual to spell out what constitutes strangulation, how to determine the signs, and how to go about handling the aftermath and the trauma.
“Here in Northern Kentucky, we already had guidelines and a plan for people who have been victimized,” said Jill Brummett, Forensic Nurse Manager for all six locations of St Elizabeth Hospital. “When the state got around to a creating a manual, they realized that we already had a start on it, so they asked us to help. My coordinator, Selena McCormick, and I were asked to help put the manual together. Then my team and I trained at the Strangulation Institute that is based out of California.”
Brummett said that at St Elizabeth they saw about 600 cases of violence last year, and there were about 300 cases of domestic abuse.
“My team and I work 24/7, 365 days of the year,” she explained, saying she has three nurses who were funded by a grant, and four other nurses funded by St Elizabeth plus part time nurses. “Most of our calls come from the Emergency Room. We respond to domestic violence, child sexual abuse, elder abuse, and human trafficking. Some of the children’s cases are taken over to Children’s hospital.”
Brummett said that in the United States, only 25 percent of hospitals have a forensic program and that includes a Sexual Assault Nurse Examiner, or SANE program.
“When we are called into a case, we spend hours with them,” Brummett said. “Studies show it empowers them. When they come into a hospital, the first thing they think is that no one is going to believe them. The first thing I say is ‘I believe you, and I’m going to help you.’”
She explained how they determine someone has been strangled, saying some victims die in the attack. Others can have redness, bruising, abrasion, petechiae, (tiny red dots on the skin), and subconjunctival hemorrhage, which are the top five symptoms the team looks for.
There are a lot of things that can be injured inside a neck. The neck contains carotid arteries, and jugular veins, as well as the trachea. Sometimes just the act of choking someone, and the resulting struggle, can cause a blood clot that could break off and travel, so they need a CTA, or a cat scan plus which looks at vessels. Strangulation can compromise the trachea so that breathing is difficult, or compromise the ebb and flow of blood to the brain via the carotid and jugular.
“We look at the the scalp, we look at the back of the throat, and at the eyelids for the petechiae,” Brummett said. “Chin bruising is unique to strangulation. Also, there is a big muscle behind the ears, that is attached by cartilage. It only takes 11 pounds of pressure to occlude a blood vessel. It takes 20 pounds of pressure to open a soda can. It takes 33 pounds to crush a trachea. Many times the perpetrator wants to scare them, or to maintain control, so they don’t want to kill them, they want to almost kill them, and that is terrifying.”
Brummett said her team can look for touch DNA, which is an attacker’s DNA left on the victim’s neck.
“We have to swab the neck within 24 hours, and before the person takes a shower,” she explained. “If they have injuries, you can swab over the injuries. Many times the person who offends will reoffend, which is why it is important to get them off the street.”
Brummett said Kentucky has some of the highest numbers nationally for domestic abuse, not only for women, but also for kids. She explained that offenders like to have the power over people, and they isolate them and create fear. In return, women will go back to the offender, because of the power and the fear they hold over them.
“We see a lot of terrible things,” she admitted. “My team and I are close, and we are passionate about this. We do have to try and help each other recover sometimes, but we do it, because we need to.”
The manual came out this January, and now it is used by healthcare providers, law enforcement, advocacy groups, and prosecutors across the state.
Brummett’s team, at St Elizabeth, won first place at the International Association of Forensic Nursing Conference for their outstanding contribution to nursing research and education.
Brummett is very proud of the manual, and the work she and her team does, but that isn’t her only motivation.
“I want to save everybody’s life in Kentucky,” she said simply. “That’s why I do it.”