As the remnants of Hurricane Helene moved inland, the storm flooded a factory that makes intravenous fluids used in hospitals around the country.
The Baxter International factory in Marion, N.C., about 35 miles outside of Asheville, was evacuated right before the worst of the storm passed, according to social media posts from employees. It’s now shut down and covered in mud — like a lot of western North Carolina. Bridges leading to the facility were also badly damaged.
The facility is one of the largest suppliers of IV fluids in the country, the Food and Drug Administration says. Baxter says it will spare no expense to get the factory back online, but the company doesn’t “have a timeline for when operations will be back up and running.”
The plant’s closure, which could last weeks or even months based on similar situations in the past, could strain the supply of vital health care products.
“The kinds of things that are made at this factory are drugs that we're using every day. And in the case of sodium chloride in particular, potentially for every patient ,” says Dr. Alison Haddock, president of the American College of Emergency Physicians.
IV fluids, like sterile water, saline and fluids with carbohydrates, are used all the time in hospitals, surgery centers, nursing homes and dialysis centers. Some drugs have to be given with IV fluid. And sometimes emergency room patients can’t have anything by mouth while they’re being evaluated in case they need surgery, so they’ll get an IV to stay hydrated.
“It is the rare patient in the emergency department that doesn't end up with some IV fluids in the course of their evaluation and treatment, sort of regardless of their chief complaint,” Haddock says.
Baxter and the government get to work
Work has already begun to get the factory back up and running with about 500 people on site, the company says. “We expect this number to double in the week ahead.”
The FDA is also working with Baxter and other parts of the government to get a handle on the situation. The agency says it may look at temporarily allowing imported IV fluids to avoid shortages.
Baxter is limiting orders to prevent panic-buying that could make things worse and to make sure that the existing supply of IV solutions is distributed evenly.
“My hospital has been told we can expect 40% of what we normally order,” Chris Laman, vice president of strategy for Columbia Memorial Hospital in Astoria, Ore., told NPR in an email. “We are talking about having to limit elective surgeries.”
Baxter also sent a letter to hospitals suggesting they reevaluate their protocols for IV fluids to make sure they’re going to the people who really need them and not being wasted.
How hospitals are handing the situation
It’s difficult for hospitals to stockpile IV fluids, the way they can with pills or vials of medicine, because IV fluids are bulky. Each liter bag weighs more than 2 pounds.
“They are large,” says Michael Ganio of the American Society of Health System Pharmacists. “And so hospitals, if they're managing inventory on site, there's only so much they can keep on hand at a time. And it may be a week to 10 days’ worth, depending on which specific solution we're referring to.”
He says hospitals are already digging up old policies from when Hurricane Maria crippled a factory making similar products in 2017.
For better or worse, hospital pharmacists have been through this before.
“It's good because we can manage it,” Ganio says. “We can deliver care to patients without the patient's care being affected. It's bad because it means that we're just managing this. We're accepting that it's the status quo, and the patients aren't learning about it.”
What to expect if you’re a patient
Most of the juggling will happen behind the scenes. Patients probably won’t even realize IV fluids are in short supply unless things get really dire. The hope is that the FDA and health care system can prevent that from happening.
But shortages could affect patients in the emergency room who come in with nausea and vomiting, for example.
Often, they would be given an IV bag for hydration. But with the limited supply of these bags, these patients might be given anti-nausea medication and asked to drink a Gatorade or Pedialyte instead. That conserves the IV bags for patients in the intensive care unit and those getting surgery.
It could become a difficult situation, but patients should know they’re in good hands, says Haddock, of the American College of Emergency Physicians. “We're pros at this, and we're going to figure out how to get you the care that you absolutely need, even if it's not the easiest way.”
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