Some ER patients are half as likely to receive IV fluids since disruptions from Hurricane Helene

Patients visiting emergency departments for dehydration or nausea are half as likely to receive IV fluids now than they were before Hurricane Helene exacerbated supply shortages, according to an analysis of health records by Truveta Research.

When the storm hit western North Carolina last month, flooding and other damage halted production at Baxter’s North Cove manufacturing facility. The site typically provides about 60% of IV fluids to hospitals across the US, and the disruptions have led to multiple new shortages.

The US Centers for Disease Control and Prevention said earlier this month that “supply disruption may impact patient care and require adjustments to the clinical management of patients.” To minimize the impact on patients, federal agencies and professional organizations recommended that health care providers develop strategies to conserve resources, including substituting for oral hydration such as Gatorade or Pedialyte whenever possible and continuous assessment of the clinical need for IV fluids.

The changes were noticeable in just over a week, the Truveta analysis suggests.

The team analyzed nearly 350,000 emergency department visits for patients ages 12 and older who were admitted for dehydration or nausea or vomiting between January 1 and October 13.

It found that an average of about 6.6% of patients admitted to an emergency department with dehydration were administered saline fluids through an IV in the months prior to Hurricane Helene. But 10 days after the storm made landfall, IV administration rates dropped to about 2.5% for these patients. Similarly, for those admitted with nausea or vomiting, IV fluid administration rates fell from an average of 5.5% to 2%. These trends were consistent across age groups.

IV fluids are used for a wide range of medical purposes. Some, like dehydration, can be helped with alternative methods. But others, like organ transplant surgeries, cannot.

Conservation strategies, such as substituting oral alternatives for patients who can tolerate them, are one of many levers being pulled to help ensure that these critical supplies remain available to the people who need them most, said Dr. Chris DeRienzo, chief physician executive with the American Hospital Association.

“These conservation efforts are making a big difference in helping ensure that for patients who really have no alternative, we’ve got the supply that we need,” he said. “Every patch that we put on this patchwork quilt to try to cover that 60% hole is helpful.”

Some IV fluid manufacturing could resume in NC this week

Other efforts are also building momentum in the supply chain. On Monday, the US Food and Drug Administration announced that they extended expiration dates for many products manufactured before the hurricane hit. The agency has also allowed for temporary importation of products from some facilities outside of the US to help alleviate the shortfall, and other US manufacturers – B Braun Medical and ICU Medical – have ramped up production to help fill the gaps.

But restoring the supply chain to full capacity will take time. The first imports of IV fluids started arriving on flights about a week ago, but there’s a “range of time” when providers could start receiving new shipments, Baxter said in a statement. Baxter also expects to resume some manufacturing at its plant in western North Carolina this week, but notes that the additional supply wouldn’t reach providers for another few weeks.

“We are carefully managing the availability of both previously finished goods coming out of North Cove and the import of product to the U.S.,” the company said.

In the meantime, many hospitals are still operating with command centers focused on making real-time decisions about rationing supply.

“We’ve seen optimism about increases in supply, but you can’t really plan based on hope,” DeRienzo said. “So until you begin seeing that increased allocation consistently showing up on your loading dock, it becomes more difficult to plan longer than the time scale that a command center helps you manage.”

And the threat of respiratory virus season looms. People who have severe respiratory conditions are among those who can’t typically tolerate taking treatments by mouth.

“There’s certainly concern that as the efforts to repair the supply chain continue, we’re also running against a clock that viruses beyond our control really dictate,” DeRienzo said.

But patients shouldn’t worry that their care will be compromised, he said: “We are in the midst of some conservation efforts that are having a significant impact on utilization, but all of this work is to make sure that we have [IV fluids] for patients when they need them.”