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.”

Subject: Guidance on Crisis Intervention and Bleeding Disorders

Dear [Facility Contact / Clinical Director / Nursing Lead],

Thank you for taking such thoughtful care in planning for safety during crisis interventions. I wanted to share national guidance from the Medical and Scientific Advisory Council (MASAC) of the National Bleeding Disorders Foundation (Document 289, approved October 2024).

MASAC advises that individuals with bleeding disorders should not be excluded from standard crisis-intervention techniques, such as physical holds, restraints, or emergency intramuscular (IM) injections. These interventions should continue to follow your facility’s existing behavioral-health policies and clinical judgment, with a few additional steps to ensure medical safety:

• If a physical hold or restraint is used, a physical assessment should occur within one hour, even if the restraint has already been discontinued.

• The assessment should include consultation with the bleeding-disorder treatment team and activation of the emergency action plan if needed.

• These steps should occur even if there are no visible signs of bleeding, as internal bleeding may not be immediately apparent.

• Emergency IM injections can still be used when clinically indicated, with awareness that minor bruising or bleeding at the site may occur.

I’ve attached the relevant excerpt from MASAC Document 289, which outlines these recommendations in more detail.
Please coordinate directly with my bleeding-disorder treatment team if any of these interventions are used or considered—they can help guide assessment and care planning in real time.

Thank you for ensuring that I receive safe, coordinated care that supports both my behavioral health and my bleeding-disorder management.

Warm regards,
[Your Name]
[Your Phone / Email]
(optional) [Bleeding-Disorder Treatment Team Contact Info]