Ten percent of violent deaths in the United States are attributable to strangulation. Despite the high fatality risk of strangulation, it is often misunderstood or misidentified as something far less serious. It is necessary to understand a bit about the physiology in order to understand what makes strangulation so dangerous. The clinical sequence of a victim who is being strangled is one of severe pain, followed by unconsciousness, followed by brain death. Many times victims minimize being strangled and as a result investigators neglect to fully investigate these incidents. In order to properly assess not only the legal standards necessary for charging but also to understand the lethality of the assault, it is essential for investigators to fully document what has happened. 20 endnotes