Behavioral health facilities may have concerns about the safety of using standard crisis intervention techniques—such as physical holds, restraints, or emergency intramuscular (IM) injections—when treating individuals with bleeding disorders. These concerns are understandable given the potential risks of bleeding-related complications.

According to national guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC) in Document 289 (approved October 2024), individuals with bleeding disorders should not be categorically excluded from standard behavioral health crisis interventions. Instead, facilities should continue to use their standard crisis intervention protocols in accordance with their behavioral health policies and clinical judgment, while incorporating additional medical oversight as needed.

MASAC provides specific recommendations related to the use of physical holds, restraints, and emergency IM injections, including prompt physical assessments and timely consultation with the bleeding disorder treatment team. These steps help reduce the risk of complications while ensuring that the individual receives appropriate and timely behavioral health support.

Reassuring Facilities About Crisis Intervention Techniques

• "I understand your team may be concerned about the safety of using standard crisis intervention techniques with someone who has a bleeding disorder—that’s a valid concern, and I 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 for individuals with bleeding disorders."

• "MASAC Document 289, approved in October 2024, makes it clear that the use of physical holds, restraints, or emergency IM injections is not prohibited, but should be used in accordance with your facility’s existing policies and clinical judgment."

• "That said, there are additional steps we recommend to reduce risk:

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

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

  • It’s important to do this assessment and consultation even if there’s no visible bleeding, as internal bleeding may not be immediately apparent."

• "In terms of IM injections, there is a potential risk of bleeding or hematoma at the injection site."
  However, MASAC recommends continuing standard behavioral health practice when an emergency IM injection is clinically indicated—again, in accordance with your protocol and with our support if needed.

• "We’re here to consult with you any time an intervention like this is used or considered. We can help assess the situation and guide next steps to ensure the patient remains safe and stable."

Send the following to the facility:

• MASAC Guidance on Crisis Intervention Techniques: Personalize this email template to introduce MASAC’s recommendations for safely applying standard crisis intervention techniques on people with BD.

• Guidance on Crisis Intervention Techniques: To support safe and informed care, send the relevant national guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC):

  • MASAC Document 289 (Approved October 2024) – Include the excerpt addressing crisis intervention techniques for individuals with bleeding disorders, including:

    • Use of physical holds and restraints

    • Emergency intramuscular (IM) injections

    • Recommendations for post-intervention physical assessments and treatment team consultation