How would you guys handle strangulation, of the old-fashioned "I throttle the life out of you with my bare hands" sort? Is it some kind of Grapple combined with suffocation? Those rules would seem to take a long time to damage anybody, even if we count the stranglee (naturally) as engaged in strenous activity.

I'd say

1) Start with grapple

2) If PC wishes to strangle NPC, Opposed strength test

3) If PC wins test, NPC must take toughness test at -10% per degree of success the PC had over NPC

If NPC wins then NPC gains bonus for next round of grappling.

4) If NPC fails toughness test, they take 1D10 damage (maybe more if this turns out to be rubbish)

Just use the Grapple rules - a target that takes a certain amount of fatigue passes out, at which point the strangling one can kill them.