Strangling is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and as the auxiliary lethal mechanism in hangings in the event the neck does not break. Strangling does not have to be fatal; limited or interrupted strangling is practised in erotic asphyxia, in the choking game, and is an important technique in many combat sports and self-defence systems.
Strangling can be divided into three general types according to the mechanism used:
- Hanging—Suspension from a cord wound around the neck
- Ligature strangulation—Strangulation without suspension using some form of cord-like object called a garrote
- Manual strangulation—Strangulation using the fingers or other extremity
- Compression of the carotid arteries or jugular veins—causing cerebral ischemia.
- Compression of the laryngopharynx, larynx, or trachea—causing asphyxia.
- Stimulation of the carotid sinus reflex—causing bradycardia, hypotension, or both.
Depending on the particular method of strangulation, one or several of these typically occur in combination; vascular obstruction is usually the main mechanism. Complete obstruction of blood flow to the brain is associated with irreversible neurological damage and death, but during strangulation there is still unimpeded blood flow in the vertebral arteries. Estimates have been made that significant occlusion of the carotid arteries and jugular veins occurs with a pressure of around 3.4 N/cm2 (4.9 psi), while the trachea demands six times more at approximately 22 N/cm2 (32 psi). As in all cases of strangulation, the rapidity of death can be affected by the susceptibility to carotid sinus stimulation. Carotid sinus reflex death is sometimes considered a mechanism of death in cases of strangulation, but it remains highly disputed. The reported time from application to unconsciousness varies from 7–14 seconds if effectively applied  to one minute in other cases, with death occurring minutes after unconsciousness.
Manual strangulation (also known as "throttling") is strangling with the hands, fingers, or other extremities and sometimes also with blunt objects, such as batons. Depending on how the strangling is performed, it may compress the airway, interfere with the flow of blood in the neck, or work as a combination of the two. Consequently, manual strangulation may damage the larynx, and fracture the hyoid or other bones in the neck. In cases of airway compression, manual strangling leads to the frightening sensation of air hunger and may induce violent struggling. More technical variants of manual strangulation are referred to as chokeholds, and are extensively practiced and used in various martial arts, combat sports, self-defense systems, and in military hand-to-hand combat application. In some martial arts like judo and jujutsu, strangles or chokes that constrict blood flow are regarded as a safe way to render the opponent unconscious as opposed to other attacks, e.g., strikes to the head. During the 18th Century, a sentence of "Death by Throttling" would be passed upon the verdict of a Court-martial for the crime of desertion from the British Army.
Ligature strangulation (also known as "garroting") is strangling with some form of cord such as rope, wire, or shoe laces, either partially or fully circumferencing the neck. Even though the mechanism of strangulation is similar, it is usually distinguished from hanging by the strangling force being something other than the person's own bodyweight. Incomplete occlusion of the carotid arteries is expected and, in cases of homicide, the victim may struggle for a period of time, with unconsciousness typically occurring in 10 to 15 seconds. Cases of ligature strangulation generally involve homicides of women, children, and the elderly, but accidents and suicides occur as well. During the Spanish Inquisition, victims who admitted their alleged sins and recanted were killed via ligature strangulation (i.e. the garrote) before their bodies were burnt during the auto-da-fé. Throughout much of the 20th and 21st centuries, the American Mafia used ligature strangulation as a means of murdering their victims. Confessed American serial killer Altemio Sanchez used ligature strangulation in the rapes and/or murders of his victims.
Anti-ligature is the prevention of tying or binding. Anti-ligature devices are used to prevent vulnerable people from accidentally or intentionally self harming, (typically hanging). Anti-ligature devices and equipment are primarily used where people are considered to be 'at risk' such as hospitals, prisons and nursing homes, but can also be found in some offices and schools.
They are designed to withstand high levels of abuse and as a result are constructed from solid stainless steel and have minimal moving parts. They typically feature sloped or curved corners to which nothing can be attached and are proportioned at specific critical angles and distances with no protruding parts to prevent ligature points.
Examples of anti-ligature devices can include electronically controlled tap-less wash basins and seat-less WC pans with concealed WC cisterns and anti-ligature shower controls and shower heads.
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