It left no marks

There has been an increased focus in NSW on improving acute care for victims and survivors of non-fatal strangulation (NFS). Not all women experiencing NFS present at an emergency department in the days following the event. Some women disclose NFS months to years after the event, including to counsellors and caseworkers in community health settings. Some women have experienced repetitive incidents of NFS or engaged in sexual choking practices over long periods of time, and show signs and symptoms associated with brain injury. The Pathways Project was designed to help connect these women to appropriate healthcare.

General Practitioners (GPs) are the main coordinating point for addressing the health needs of women experiencing NFS. By working in tandem with women’s community health centres we can ensure everyone has referral pathways, protocols and services at their fingertips to provide women with useful and responsive healthcare. This might include sending the woman to the emergency department for recent or severe cases, or to neurology, psychology, brain injury clinics, or other allied healthcare providers to support her ongoing recovery process and long-term health needs.

The evidence

This Women’s Health NSW evidence brief brings together Australian research and grey literature with supporting international evidence to define the issues and illuminate data gaps relevant to preventing and responding to NFS and acquired brain injury (ABI) in the context of sexual violence. The brief covers factors that hamper appropriate medical referral and follow-up after NFS, including a lack of understanding of its potential to cause brain injury. It also highlights the need to improve Australian prevalence data to support multidisciplinary, evidence-based responses that holistically meet the needs of victims and survivors. Non-fatal strangulation and acquired brain injury in the context of sexual violence: An evidence brief

Medical case notes and record keeping

Developed in conjunction with Women’s Legal Service NSW, this 2024 Ask Lois webinar provides information about how to ensure medical case notes and record keeping can best support women who opt to pursue legal or compensatory outcomes following strangulation: Ask Lois webinar on strangulation. Women’s Legal Service NSW have also produced a separate webinar on subpoenas and record keeping that you can access here: Ask Lois webinar on subpoenas and case notes

Further training

Monash University offers a three-unit course for healthcare professionals that is designed to improve recognition and appropriate responses to adult disclosures of sexual violence. The course, Recognising and Responding to Sexual Violence in Adults, is delivered in online modules over the course of six weeks and covers NFS in the second training module. It is delivered by the Victorian Department of Forensic Medicine as Continuing Professional Development (CPD) training and accredited by multiple professional bodies, including the Royal Australian College of General Practitioners (RACGP) and the Australian College of Nursing (ACN).

Further reading

Australian Journal of General Practice (2022): ‘I thought I was About to Die’: Management of Non-fatal Strangulation in General Practice

Victorian Institute of Forensic Medicine (2022): It’s Never OK [VIDEO]:

Agency for Clinical Innovation (2022): Managing non-fatal strangulation in the emergency department

The Royal Australian College of General Practitioners (2023): Responding to non-fatal strangulation: What you cannot see [webinar]

The Royal Australian College of General Practitioners (2022): Abuse and violence: Working with our patients in general practice

NSW Health (2020): Responding to Sexual Assault (Adult and Child) Policy and Procedures

Women’s Legal Service NSW (2019): “When she talks to you about the violence”: A toolkit for GPs in NSW

Medicare Benefits Schedule Online (2023): Introduction of new Level E consultation items lasting 60 minutes or more

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