The U.S. Army Military Police School's Behavioral Sciences Education and Training Division recently completed two of the three scheduled pilot courses for their new three-day Multidisciplinary Strangulation Response and Investigation Course as a result of the changes in the Uniform Code of Military Justice.

David Zeliff, U.S. Army CID Forensics Program manager, said the UCMJ now has a new offense for strangulation, and it is a felony.

The course, created in order to train first responders to better identify the signs and symptoms of strangulation, includes training and education on such topics as: legal changes and implementations, methods and mechanisms of strangulation, medical-legal language, pediatric strangulation, recognition of neurological/physical signs and symptoms, trauma informed interview response, lethality protocols, multidisciplinary collaboration and proper investigative report writing.

"We've keyed in on what law enforcement can do, what medical can do and what family advocacy can do," said Sonya Barlow, BSETD training specialist. "The seriousness of strangulation means we need a coordinated response. We need all first responders on the same sheet of music, so to speak."

One in four women and one in seven men in the U.S. have been a victim of severe domestic abuse, according to a survey conducted by the Center for Disease Control and Prevention. When strangulation is involved, the likelihood of death caused by that abuse increases.

"With domestic abuse and strangulation, it is 700 times more likely that an individual will be a victim of homicide," Barlow said.

Barlow said the division also created a First Responder's Lethality Assessment, a Domestic Violence Lethality Assessment and a form that documents bruises and various physical indicators, as well as some emotional indicators that go along with strangulation.

"We built protocols in conjunction with this," Zeliff said. "Those protocols are going to be issued to all first responders, so when they respond to a scene, rather than looking and saying there are no marks of violence, it will prompt them to ask questions. We hope those questions lead them to where we might be able to stop it after the first incident."

In creating this course, Barlow and Zeliff said they hope to make more people aware of the dangers of strangulation.

"It's a much-needed course," Barlow said. "The sooner we see the signs, the better, and the more people asking the right questions means we can connect victims with the right resources. If a person has been strangled, he or she needs a different level of care."

Barlow said some signs and symptoms of strangulation are not visible right away, and some are never shown. That is why it is important to learn the indicators.

"If they have lost consciousness, that intensifies their chances to have what we call small strokes, or cryptogenic strokes, where they can suffer memory loss, amnesia -- and researchers have even linked it to depression later on," Barlow said. "They don't know why they are feeling the way they are feeling, and eventually they go into a deep depression."

Zeliff said the lack of oxygen causes serious injury to the brain.

"For anyone that has lost consciousness, it creates an anoxic brain injury, and anyone that is suffering from an anoxic brain injury will never be the same," he said. "There are a lot of things nurses and doctors can do for people, but once they've suffered anoxic brain injury, that can't be fixed. They can be taught to live with it; they can be taught to adapt, but they can't be fixed, and so it often creates a permanent disability, and some people get progressively worse over time from those injuries, as well."

Five additional courses have been scheduled following the pilot courses.