Mandatory Reporter Training Changes Generate Need for Guidance

From the Iowa Hospital Association

Iowa lawmakers recently passed House File 731 changing Iowa’s mandatory reporter training guidelines. As a result, IHA has received a number of questions from Iowa hospitals.

The bill separates child abuse and dependent adult abuse training and requires two hours of training for each every three years (reduced from the five years previously). Due to an amendment, mandatory reporters will be in compliance for an additional three years if they complete at least one hour of training prior to the original three-year expiration period.

The Department of Human Services (DHS) is required to create the trainings and organizations should supplement it with additional issue-specific training. Child abuse and dependent adult abuse training certificates issued before July 1 remain effective with a five-year expiration date.

HF731 has been sent to the governor’s office and is expected to be signed. IHA will work with DHS to get answers and guidance for Iowa hospitals as these changes are implemented. Questions can be directed to Erin Cubit at IHA.

New Montana law allows emergency care providers to offer other aid

From the AP:

Montana Gov. Steve Bullock has signed a bill allowing emergency care providers to offer non-emergency medical assistance in their communities to reduce noncritical calls to 911, especially in rural areas.

The providers could fill gaps in the current medical system by helping people manage their medicine or chronic illnesses, giving them a ride to their doctor’s office or home from a hospital, or connecting them with other medical or mental health services, supporters said.

Rare and strange ICD-10 codes

From Jon Cook:

ICD-10 is a set of around 70,000 diagnosis codes. ICD stands for International Statistical Classification of Diseases and Related Health Problems. The verbosity of the name is foreshadowing.

Some of the ICD-10 codes are awfully specific, and bizarre.

For example,

  • V95.4: Unspecified spacecraft accident injuring occupant
  • V97.33XA: Sucked into jet engine, initial encounter
  • V97.33XD: Sucked into jet engine, subsequent encounter

As I understand it, V97.33XD refers to a subsequent encounter with a health care professional, not a subsequent encounter with a jet engine. But you have to wonder how many people who have been sucked into a jet engine survive to have one, much less two, medical visits.

Measles Outbreaks in the United States

From the Nebraska Department of Health and Human Services Health Alert Network, an Advisory (hat tip: Dr. Menadue):

From January 1 to May 3, 2019, 764 cases of measles were reported from at least 22 states. This is already the greatest number of cases in one calendar year since measles was declared eliminated in the United States in 2000. A large outbreak is ongoing in New York City and New York State, as well as multiple countries.


What should Clinicians Do?
 Consider measles in patients of any age who have a febrile rash illness AND clinically compatible symptoms (cough, coryza, and/or conjunctivitis). Measles rashes are red, blotchy, and maculopapular and typically start on the hairline and face and spread downwards to the rest of the body.
 Obtain a thorough history on such patients, including: recent exposure to anyone
with a rash and fever illness, recent travel to other states and countries or contact with
international travelers in the prior three weeks; and prior vaccinations with measles.
 If you suspect measles, isolate the patient immediately and alert the state or local
health department as soon as possible. To prevent transmission in healthcare settings,
airborne infection control precautions should be followed stringently. Further
information is available at
 Laboratory testing: Obtain specimens for all suspected cases of measles. Notify the
state (402-471-6450) or local health department if you order any measles testing.
o PCR is the preferred diagnostic test up to 9 days after rash onset.
 A throat swab should be collected on days 0-5 after rash onset.
 A throat swab plus urine sample should be collected on days 6-9.
o Specimens can be sent to the Nebraska Public Health Lab (with prior notice).
o Measles IgM can also be helpful depending on timing and vaccine history.

CDC urges healthcare professionals to ensure that all patients are up to date on measles
containing vaccines. MMR vaccination is especially important for healthcare professionals
and international travelers.
 Discuss the importance of MMR vaccine with parents. When parents have questions,
it does not necessarily mean they won’t accept vaccines. Sometimes, they simply
want your answers to their questions.
 Ensure all patients are up to date on MMR vaccine.
o Infants 6-11 months need 1 dose of MMR vaccine before international travel.
o Children and teenagers need 2 doses of MMR: the standard ACIP schedule
recommends doses at 12-15 months and 4-6 years (at least 28 days apart).
o Adults born during or after 1957 should have documentation of at least one
dose of MMR or other evidence of measles immunity. Persons in this age
group who need a 2nd dose includes:
 Postsecondary educational students
 International travelers
 Healthcare personnel
 Persons with HIV and a CD4 count ≥ 200 cells/µl for at least 6 months
 Household or close personal contacts of immunocompromised persons
with no evidence of immunity.
o Older adults born before 1957 are generally considered immune to measles,
mumps, and rubella. This is acceptable evidence of immunity unless they
work in healthcare facilities.

Share information about measles with parents and the public in your office.
 CDC has a recent article for parents about measles that you can link to from your
consumer-friendly websites:
 CDC has a full suite of resources to share with parents, including printable fact
sheets, posters, and printable infographics:

Learn more about measles and encourage others to do the same.
Below is information about measles that you can promote to other healthcare professionals:
 For more information, including guidelines for patient evaluation, diagnosis and management, visit:
 View TEDMED at CDC: Measles—Making a Disease Disappear conference talk
from 2013:
 Infant Immunization FAQs in English and Spanish:
 Measles fact sheet for parents in English and Spanish:

Thank you for your assistance.


Walgreens is training pharmacists to spot mental health, substance abuse problems

From Becker’s:

Walgreens has launched a program to train pharmacists and pharmacy staff to better identify mental health and substance abuse issues in their patients.

To create the “Mental Health First Aid” training program, the pharmacy retail giant partnered with the National Council for Behavioral Health and the American Pharmacists Association.

The goal of the program is to train participants to better understand risk factors for mental health and addiction issues, spot warning signs and know how to help patients.