A woman’s risk of being killed after a nonfatal strangulation can increase seven-fold, research shows. But victims often minimize such choking attacks, and because the injury often isn’t obvious, police or care providers may not document it.

To help better identify victims of such abuse and get them the help they need, YWCA Utah and other community partners, including the Salt Lake City mayor’s office, police department and fire department, have rolled out new protocols for Salt Lake City emergency responders.

The coalition began training members in the new strangulation protocol in April. Members, including Family Justice Center sexual assault nurse examiner Kristin Hall, have now trained 1,000 Salt Lake City firefighters, police officers and 911 dispatchers in how to recognize and document the signs of strangulation, more clearly ask and determine whether a victim has been strangled, and better connect them with medics to check for potential damage, the group announced last week.

Nurses have helped nearly 20 people since emergency responders implemented the protocol, said Devon Musson Rose, YWCA’s chief domestic violence services officer, in an email.

Salt Lake City police Sgt. Brandon Shearer said more than 250 SLCPD officers have already been trained in the new protocol, and he expects the rest of the force will be trained in coming months.

The protocol, he said, is a “high priority” for the department. He said it is more “victim-focused” than officers’ previous training and reinforces the harm strangulation can cause, even when there aren’t physical signs of trauma.

“It’s helping officers understand the serious nature of something that has risen to the level of strangulation,” Shearer said.

When a woman is strangled, her risk of later being the victim of an attempted homicide or being killed increases dramatically. Rose pointed to resources from the Training Institute on Strangulation Prevention, which provides training to family violence workers worldwide.

The institute says strangulation is the “ultimate form of power and control where the batterer can demonstrate control over the victim’s next breath: it may have devastating psychological effects or a potentially fatal outcome."

Resulting internal injuries can culminate in a stroke or death. Survivors might also experience headaches, numbness, vision changes, poor concentration, anxiety and post-traumatic stress disorder, according to the YWCA.

The protocols mandate that whenever a victim reports being strangled, or an officer sees physical signs of strangulation, the officer notifies 911 dispatchers. Those dispatchers, in turn, tell a sexual assault nurse examiner. Meanwhile, medics at the crime scene will examine the victim and take her or him to a hospital if necessary, Rose said.

The sexual assault nurse examiner will then meet with the survivor, explain the dangers of strangulation and get that person medical treatment. Then, they will follow up with the victim to make sure they don’t have any delayed symptoms.

A police officer at the scene will go over similar information with the victim if they do not go to a hospital, Rose said.

According to Rose, the goal of the new training is simple: “To educate survivors of the risks of strangulation, link them to critical and possibly life saving medical care and promote increased offender accountability.”

Editor’s note: If you are in an abusive relationship and need help, call the YWCA 24-Hour Crisis Line at 801-537-8600 or seek free, confidential walk-in services at Salt Lake Area Family Justice Center at the YWCA from Monday through Friday, between 9 a.m. and 4 p.m. Those who are experiencing intimate partner violence, or know someone who is, can also call the Utah Domestic Violence Link Line, 1-800-897-LINK (5465), or the Utah Rape and Sexual Assault Crisis Line, 1-888-421-1100. In an emergency, call 911.

Correction: 2:30 p.m. June 11: This story has been updated to correctly characterize YWCA's role in training community partners. Partners, including a sexual assault nurse examiner, conducted the trainings.