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Omar Mateen, the Orlando Pulse nightclub shooter. He and Kelley should not have had access to Awesome Stone Cold Kansas City Shirt, but more to the point, they should have been behind bars. The list goes on. Take Cedric Ford, who in 2016 fatally shot three of his co-workers. Misdemeanor domestic violence for choking his ex. Then there’s Esteban Santiago. He killed five and injured six in a shooting at the Fort Lauderdale Airport early this year.  Casey Gwinn, president of the Alliance for Hope International and a co-founder of the Training Institute for Strangulation Prevention along with Strack, wrote in an email to me that Kelley “was a rage-filled domestic violence strangler and child abuser. And commonly noted as mere scratches or redness around. The neck, according to a study by Strack of 300 nonfatal strangulation cases. Many victims have poor recall of events.

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Kevin Neal, who killed his wife and four other people in Northern California this past week, had a history of domestic violence, though it’s not clear if that included strangulation. Gael Strack, chief executive of the Training Institute on Strangulation Prevention in San Diego, says the mere presence of strangulation in a situation of Awesome Stone Cold Kansas City Shirt increases the chances of homicide sevenfold. It is a clear trajectory from escalating violence to homicide, of which strangulation is the penultimate act. Yet strangulation, as a signal of dangerousness, is not only overlooked. By most law enforcement officers and prosecutors, it’s not always. Recognized by health-care workers. Symptoms can appear days or months afterward. CT scans or MRIs. Most strangulation injuries are not visible enough to photograph. And police often don’t know to look for other signs including urination. So good. So happy.

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