Strangulation is known for its manipulative effectiveness to gain powerful control over a victim and its frequent overlap with sexual perpetration. This talk discusses the often-missed opportunity to identify the co-occurrence of strangulation, suffocation and drowning in human trafficking cases. There is a layered risk of frequent and repeated form of asphyxiation of trafficked victims by the pimp, the buyers and serial predators that target this vulnerable population. Pimps strangle to gain necessary compliance and control over a trafficked person. Financial incentive for both the pimp (who can upcharge to add strangulation to a sex act) and the trafficked victim (who must meet a daily quota) may result in multiple strangulations per day, and repeated exposure by multiple perpetrators.� Despite the severe trauma impact, human trafficking curriculums and screening tools fail to capture the existence and impact of this particular type of assault. Rarely do the survivors receive medical assessment, treatment or care to address the specific risks associated with human trafficking. These forces need to be more proactive in looking for, identifying, collaborating and preventing this type of violence. Identification of these events will enable law enforcement and the medical communities to better serve this vulnerable population.