This content is designed for professionals (e.g. health workers, police officers, support workers, social workers) to identify and respond appropriately to non-fatal strangulation or suffocation (NFS), with emphasis on survivor safety, medical urgency, and best-practice response.
What is Non-Fatal Strangulation or Suffocation?
Non-fatal strangulation (NFS) occurs when pressure is applied to the neck or throat that restricts airflow or blood flow without causing immediate death. It is often used as a form of control, intimidation, and violence in sexual assaults and domestic abuse. NFS can have serious, life-threatening medical consequences - even when there are no visible injuries.
Strangulation or suffocation is recognised as a distinct and serious form of harm, and in many cases, it is an indicator of escalating violence and increased homicide risk.
Suffocation is depriving someone of air which affects their normal breathing. It is often not recognised as a form of NFS.
Methods of non-fatal suffocation could include; putting a hand over the mouth and nose, compressing the chest or any other force or suppression applied to cause a restriction of breath.
Why it is critical to identify Non-Fatal Strangulation or Suffocation (NFS)
- It may not leave visible signs: many victims of NFS do not have external marks, absence of visible injury does not mean there is no internal damage.
- Delayed medical complications are common: symptoms like voice changes, swallowing difficulties, dizziness, or memory loss may appear hours or days later.
- It increases the risk of future harm: survivors of NFS are at significantly higher risk of serious injury or fatal assault in the future.
Physical signs may include:
- Redness, bruising, or scratches around the neck or jaw
- Hoarseness, voice changes, or difficulty speaking
- Breathing difficulties or coughing
- Difficulty swallowing and drooling
- Loss of consciousness (even if only briefly)
- Headaches or dizziness
- Vision changes or confusion
Behavioural indicators may include:
- Fear of speaking about what happened
- Delayed disclosure of strangulation
- Memory gaps or loss of time during the assault
- Emotional distress disproportionate to visible injuries
If a person discloses that they were strangled or suffocated, take it seriously - regardless of visible injuries.
Your response should be:
- Trauma-informed and non-judgmental.
- Medical first: Refer immediately for a clinical assessment. Internal injuries may not be visible but can be life-threatening.
- Supportive and empowering: Validate their experience. Use language such as: “I’m really concerned for your safety - what you’ve described can be very serious.”
- Document clearly: Record what the person said in their own words, describe any visible signs, and note any symptoms or concerns.
- Refer and signpost: Treetops SARC can offer immediate medical care, forensic medical examination (if appropriate), emotional support, and referral to safeguarding and advocacy services.
Next steps
Professionals can contact us directly to discuss a referral, seek advice, or arrange urgent care for someone who may have experienced non-fatal strangulation.
If you’re unsure, reach out.
If you’re working with someone who may have experienced non-fatal strangulation or suffocation, even if you’re uncertain, contact Treetops SARC for confidential advice and support.
Non Fatal Strangulation (NFS) training
Please click here to some free training for professionals - provided by SafeLives