Background: Near-hanging is a critical medical emergency with potential for severe neurological and systemic complications. Early assessment and intervention are crucial in determining outcomes. Objectives: To evaluate the clinical profile, management, and outcomes of patients presenting with near-hanging to a tertiary care center. Materials and Methods: This prospective observational study included 100 patients aged >12 years who presented within 6 hours of a hanging incident to the Emergency Department of Government Villupuram Medical College, Tamil Nadu, India, from November 2023 to November 2024. Demographic data, clinical findings, investigations, and outcomes were recorded. Severity was assessed using the Glasgow Coma Scale (GCS) and Simplified Acute Physiology Score II (SAPS II). Results: The mean age of participants was 41.9 ± 15.4 years, with 59% males. Ligature marks were observed in 96% of cases. The mean time to first medical contact was 39.1 ± 17.4 minutes. Low GCS at admission and prolonged hanging duration were associated with poor outcomes. Overall, 67% of patients survived with full recovery, while 12% died and 21% had neurological or psychiatric sequelae. Mechanical ventilation was required in 22% of patients on day 1, with gradual improvement over 10 days. Conclusion: Near-hanging carries significant risk of mortality and neurological complications. Early emergency intervention, prompt airway and physiological management, and close monitoring improve survival and reduce adverse outcomes. Public awareness and psychiatric evaluation are essential for prevention and long-term care.