New Directive Establishes Multidisciplinary Response to Strangulation and Smothering Attacks

Attorney General Matthew J. Platkin today issued a Law Enforcement Directive establishing the framework for a response team — known as the “Breathing/Blood Flow Restriction Event: Advocacy, Treatment, Help, and Empowerment” (BREATHE) Team — responsible for responding to crimes of nonfatal strangulation and smothering.

Attorney General Law Enforcement Directive No. 2023-03 requires County Prosecutors to develop and implement procedures to refer victims of nonfatal strangulation and/or smothering for a forensic medical examination. This Directive builds upon the successful procedures already implemented in several counties, which established strangulation and smothering response teams. These BREATHE teams will consist of a qualified Forensic Nurse Examiner (FNE) to conduct a forensic medical exam, a law enforcement officer, and a victim advocate. This Directive also sets forth clear parameters that will help establish better emergency care to victims of these crimes and improve the quality of forensic evidence and information collected during these investigations for future prosecution.

Strangulation is one of the most lethal forms of domestic violence and correlates to an approximately 750 percent increased risk of homicide of the domestic violence victim by the offender. Individuals with a history of strangling intimate partners have been linked to being perpetrators in officer-involved critical incidents, intentional line of duty homicides, and mass murders. Many victims of strangulation exhibit no visible signs of injuries, but, because of the physical trauma inflicted, they may sustain life-threatening internal injuries, including traumatic brain injury, damage to carotid arteries, stroke, and/or permanent visual impairment. Even when victims exhibit noticeable injuries associated with strangulation, the injuries may appear minor and limited to the area of the body where their abuser applied pressure.

This Directive is the latest step taken by Attorney General Platkin to address and combat violent crime through a victim-centered approach that prioritizes a victim’s health and well-being to minimize re-traumatization associated with the criminal justice process. By providing the support of victim advocates and service providers through the responding BREATHE Teams, survivors are empowered to engage and participate in the process.

The BREATHE initiative is made possible due to the investments in Governor Murphy’s Fiscal Year 2024 budget, which appropriates $4.2 million for FNEs as well as Sexual Assault Nurse Examiners. Previously, the State relied solely on federal Victims of Crime Act (VOCA) dollars for these nurse examiner resources. While VOCA funds have decreased over the years, the State has not only stepped up to ensure a continuity of these essential services, but has allowed for an expansion of on-call, activation, and exam fees to include non-fatal strangulation cases.

“Victims of violent crimes endure both physical and emotional pain, and implementing BREATHE teams in every county across the state will ensure that they have access to the comprehensive and specialized care they need and deserve,” said Attorney General Platkin. “We are committed to supporting survivors at every step on what can be a long and difficult road to healing and justice. We are grateful to Governor Murphy and the Legislature for including the necessary funding to support this expansion of Forensic Nurse Examiner services in the State’s FY24 budget.”

“The Division of Criminal Justice’s first priority is to save lives,” said J. Stephen Ferketic, Director of the Division of Criminal Justice. “Strangulation and smothering are two of the most lethal forms of violence, particularly in the intimate partner context. This Directive will help ensure survivors of these assaults receive the life-saving medical care they need and that their injuries are documented for future investigation and prosecution.”

“New Jersey’s Sexual Assault and Domestic Violence Response Teams have proven that a multidisciplinary response to survivors of interpersonal violence are critical for supporting someone in the aftermath of victimization,” said Patricia Teffenhart, Executive Director of the Division of Violence Intervention and Victim Assistance. “Applying these same time-sensitive, survivor-centered, trauma-informed principles to support survivors of strangulation and smothering will save lives, connect survivors to services, and support those impacted by this heinous crime along their journey of healing.”

“The New Jersey Coalition to End Domestic Violence is thankful to the Attorney General’s Office for creating BREATHE Teams,” said Denise Higgins, Legal Director of the New Jersey Coalition to End Domestic Violence. “Strangulation and other forms of breathing restriction by an intimate partner are strong predictors of future homicide. However, strangulation often goes unrecognized because victims may not have immediate visible injuries. This new response will provide victims with the necessary resources and support during this crucial stage. We value this multi-disciplinary approach that prioritizes the needs of victims and brings us closer to our shared goal of eradicating domestic violence in New Jersey.”

Under the new Directive, FNEs will receive specific training to be able to evaluate patients who have reported strangulation and/or smothering victimization. FNEs utilize specialized training, techniques, and equipment to gather samples, specimens, and photographs that may be used in the investigation and/or prosecution of these cases. As a result, forensic medical examinations of strangled and/or smothered victims can provide critical, life-saving medical services, as well as preserve potential evidence for future prosecution.

Pursuant to the Directive, FNEs, in coordination with law enforcement and advocates, will respond to any reported cases of strangulation and/or smothering that meet the following criteria:

The victim describes being strangled and/or smothered;
The victim consents to the forensic medical examination; and
The incident occurred within the past five (5) days and/or the victim exhibits continued visible signs of strangulation and/or smothering injury, or the victim reports experiencing continued symptoms of strangulation and/or smothering.

The Division of Criminal Justice, in collaboration with the 21 County Prosecutors, will be responsible for providing statewide training to FNEs, law enforcement officers, prosecutors, and stakeholders about the procedures to be utilized by, and services provided by, BREATHE Teams across the state. Each county prosecutor’s office will work to implement county-specific procedures that satisfy the required framework established by the Attorney General’s Directive. Under the Attorney General’s Directive, BREATHE Teams will be operational in all 21 counties by January 1, 2024.

The standards and procedures in this Directive were developed by the Division of Criminal Justice Domestic Violence/Sexual Violence Policy and Training Unit, led by Deputy Director Theresa Hilton, in close collaboration with the Division of Violence Intervention and Victim Assistance, which was established by Attorney General Platkin in September 2022 to coordinate and advance the Office of the Attorney General’s victim-centered strategy by bringing together victim-related and violence intervention and prevention services currently dispersed throughout the Department of Law and Public Safety.

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