In late September 2024, Hurricane Helene tore through the southeastern United States, leaving a trail of destruction that extended far beyond flooded homes and damaged infrastructure. One of the most significant and ongoing impacts of the storm has been a critical shortage of intravenous (IV) fluids, affecting hospitals nationwide. The closure of a major manufacturing facility in North Carolina, responsible for producing about 60% of the nation’s IV fluid supply, has forced healthcare providers to ration supplies, delay non-emergency surgeries, and adopt alternative hydration methods to ensure patient care. As hospitals navigate this crisis, the situation highlights the fragility of the U.S. medical supply chain and raises urgent questions about how to prevent similar disruptions in the future.
The Root of the Crisis
Hurricane Helene, a Category 4 storm, made landfall on Florida’s Gulf Coast on September 26, 2024, before moving through the Southeast, causing widespread flooding and damage. Among the casualties was Baxter International’s North Cove manufacturing plant in Marion, North Carolina, located about an hour east of Asheville. This facility, one of the largest producers of IV fluids and dialysis solutions in the country, was severely flooded, forcing a complete halt in production. Baxter, which supplies roughly 60% of the IV fluids used in U.S. hospitals, has been unable to resume full operations, leaving healthcare providers scrambling to manage dwindling supplies.
IV fluids are a cornerstone of modern healthcare, used to hydrate patients, deliver medications, and support critical procedures like surgeries and dialysis. The sudden loss of such a significant portion of the nation’s supply has created a ripple effect, with hospitals from coast to coast feeling the strain. According to the American Hospital Association, the North Cove plant produced approximately 1.5 million IV bags daily before the storm. With production disrupted, hospitals have been forced to implement conservation measures to stretch their limited inventories.
Hospitals Adapt to the Shortage
Across the country, hospitals are taking creative and sometimes drastic steps to cope with the IV fluid shortage. Many are rationing IV bags, reserving them for the most critical patients, such as those undergoing major surgeries or requiring intensive care. For less severe cases, healthcare providers are turning to alternative hydration methods, such as encouraging patients to drink oral rehydration solutions like Gatorade or Pedialyte when possible. In some hospitals, nurses are administering medications through manual syringe injections, known as “push medications,” instead of using IV drips, which can be more time-consuming and, in some cases, painful for patients.
Dr. Jonathan Stallkamp, chief medical officer at Main Line Health in Pennsylvania, explained the challenge: “We’re changing how we hydrate patients. Our system uses about 1,000 IV bags a day, but now we’re getting only half of our normal supply.” Similar stories are unfolding nationwide. In Washington, D.C., Inova Health System has reduced its IV fluid usage by 55% since early October through aggressive conservation measures, according to Sam Elgawly, chief of resource stewardship at Inova.
Some hospitals have postponed non-emergency surgeries to conserve IV fluids for urgent cases. While major health systems like the Cleveland Clinic and Mount Sinai report they have not yet needed to cancel procedures, others are not as fortunate. A survey conducted by Premier, a health analytics consulting firm, found that 86% of U.S. healthcare providers are experiencing IV fluid shortages, with 54% reporting supplies lasting 10 days or less. Nearly 17% of respondents have already postponed elective surgeries, and 58% are considering doing so if the shortage persists.
The Broader Supply Chain Problem
The IV fluid shortage caused by Hurricane Helene is not an isolated incident but rather a symptom of a deeper issue: the fragility of the U.S. medical supply chain. The concentration of IV fluid production in a single facility highlights a critical vulnerability. Baxter’s North Cove plant was responsible for such a large share of the nation’s supply that its closure created an immediate crisis. This issue is compounded by the fact that IV fluids are low-cost, high-volume products with slim profit margins, which discourages other manufacturers from entering the market or maintaining excess capacity.
This is not the first time hurricanes have disrupted the IV fluid supply. In 2017, Hurricane Maria devastated Puerto Rico, where Baxter operated three manufacturing plants, leading to months-long shortages. The recurrence of such disruptions has prompted experts to call for systemic changes. Erin Fox, associate chief pharmacy officer at the University of Utah, has tracked drug shortages for two decades and argues that congressional action is needed to address the lack of manufacturers and the risks of production concentration in disaster-prone areas.
Rob Handfield, a supply chain management professor at North Carolina State University, noted that the low profitability of IV fluids makes the supply chain particularly vulnerable. “They’re heavy, bulky, and don’t cost a lot, so you tend to produce them close to where they’re needed,” he said. This reliance on local production, combined with hospitals’ just-in-time inventory practices, leaves little room for error when a major supplier goes offline.
Government and Industry Response
In response to the crisis, the federal government and other manufacturers have taken steps to mitigate the shortage. The U.S. Food and Drug Administration (FDA) has declared shortages for three IV fluid products—Dextrose 70% IV solution, Lactated Ringers IV Solution, and Peritoneal Dialysis Solution—and has authorized the temporary importation of 19 IV fluid products from countries like China, Canada, and Ireland. The FDA has also relaxed rules to allow hospitals to compound their own IV solutions, a process typically subject to strict regulations.
The Biden administration has invoked the Defense Production Act to prioritize Baxter’s access to materials needed to rebuild and clean its North Cove facility. This wartime power ensures that Baxter can secure resources even amid supply chain disruptions. The Department of Health and Human Services (HHS) has also worked with FEMA to restore infrastructure, such as a temporary bridge used to transport IV products from the plant. HHS Secretary Xavier Becerra, who toured the damaged facility in November 2024, emphasized the government’s commitment to supporting recovery efforts.
Other manufacturers, such as B. Braun Medical and ICU Medical, are ramping up production at their facilities in California and Florida to help fill the gap. However, B. Braun’s Daytona Beach plant faced its own challenges when Hurricane Milton threatened Florida in October 2024, forcing the company to move finished products to a safer location. Despite these efforts, experts warn that the shortage could persist for months, especially with the respiratory virus season increasing demand for IV fluids.
Looking Ahead: A Call for Resilience
As of December 2024, Baxter reported that its North Cove facility had resumed production at 85% of pre-hurricane levels, with full capacity not expected until March 2025. While this progress is encouraging, hospitals continue to operate under strained conditions, and the looming threat of seasonal illnesses could exacerbate the situation. Nurses like Ashley Bunting at Mission Hospital in Asheville, North Carolina, describe the ongoing challenges: “We’re limited to water bottles for patients, and we can’t provide ice chips. The IV fluids we do have are reserved for the most critical cases.”
The IV fluid shortage has sparked renewed calls for policy reforms to strengthen the medical supply chain. The American Hospital Association has urged the Biden administration to declare a national emergency and implement measures like extending the shelf life of IV fluids and identifying additional international suppliers. Congresswoman Debbie Dingell of Michigan has also called on HHS to address the systemic vulnerabilities exposed by this crisis.
For now, healthcare providers are doing their best to adapt, but the situation remains precarious. The IV fluid shortage serves as a stark reminder of how interconnected and vulnerable our healthcare system is to natural disasters. As climate change increases the frequency and severity of such events, building a more resilient supply chain will be critical to ensuring that hospitals can continue to provide life-saving care.
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