Behavioral-health facilities may worry about the safety of using standard crisis-intervention techniques—such as physical holds, restraints, or emergency intramuscular (IM) injections—for someone with a bleeding disorder. These concerns are understandable because these actions can, in some cases, increase the risk of bleeding.

However, national guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC) in Document 289 (approved October 2024) makes it clear that:

“Individuals with bleeding disorders should not be categorically excluded from standard behavioral health crisis interventions.”

Facilities should continue to use their standard crisis-intervention protocols based on their own behavioral-health policies and clinical judgment, while adding a few simple steps to keep the person safe.

MASAC recommends:

• Conducting a physical assessment within one hour after a hold or restraint—even if it’s already been discontinued.

• Consulting with the bleeding-disorder treatment team after any restraint or injury to determine if further monitoring or treatment is needed.

• Activating the emergency action plan if there are any signs or symptoms of bleeding.

• Continuing to use emergency IM injections when clinically indicated, with awareness that bleeding or bruising at the injection site can occur.

These steps allow facilities to maintain safe, effective behavioral-health practices while minimizing medical risks.

Reassuring Facilities About Crisis Intervention and Safety

• “I understand your team may be concerned about using physical holds, restraints, or emergency IM injections with someone who has a bleeding disorder—that’s completely valid, and I really appreciate your caution.”

• “According to national guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC), facilities should continue using their standard crisis-intervention protocols, even when working with individuals who have bleeding disorders.”

• “MASAC Document 289 (approved October 2024) explains that the use of holds, restraints, or emergency IM injections isn’t prohibited—it just requires the same good clinical judgment and a few extra precautions.”

• “For example, MASAC recommends that if a physical hold or restraint is used, a physical assessment should occur within one hour, even if the restraint has already been discontinued.”

• “That assessment should include a consultation with the bleeding-disorder treatment team and, if needed, activation of the emergency action plan.”

• “Even if there’s no visible bleeding, internal bleeding can occur, so checking in with the treatment team is important.”

• “For emergency IM injections, MASAC says to continue following your normal behavioral-health protocol. The injection might cause some bruising or bleeding at the site, but it’s still appropriate when clinically necessary.”

• “My treatment team is happy to consult any time one of these interventions is used or considered. They can help assess the situation, guide next steps, and make sure I remain safe and stable.”

Send the following to the facility:

• Guidance on Crisis Intervention and Bleeding Disorders: Personalize this email template to share MASAC guidance on crisis interventions for people with bleeding disorders.

• Medical and Scientific Advisory Council (MASAC) of the National Bleeding Disorders Foundation (Document 289, approved October 2024).

• Considerations for crisis intervention techniques for persons with bleeding disorders: Excerpt from MASAC 289