Responding to a Shortage

On September 27, 2024, Hurricane Helene made landfall in Florida and proceeded to ravage North Carolina with historic floods. Unprecedented amounts of rainfall in the Asheville, NC area, led to widespread flooding and destruction of the area’s infrastructure. This destruction included the Baxter International Inc. manufacturing plant, where 60% of the nation’s intravenous (IV) and dialysis fluids are produced, which suffered significant flooding and loss of product. With over 400 hospital and healthcare facilities in HHS Region 7 (IA, KS, MO, and NE) and limitations on information of when the supply chain would recover, facilities looked for guidance from the Region VII Disaster Health Response Ecosystem (R7DHRE) on how to best navigate the situation. This event gave the R7DHRE (part of ASPR’s Regional Disaster Healthcare Response System) a chance to exercise response capabilities they had been working to build over the last 6 years of the grant (see figure below).

Within days of the hurricane shutting down the Baxter plant, officials from the state hospital associations in HHS Region 7 requested that the R7DHRE convene a working group to address the situation. This working group began meeting within a week of the Baxter plant closure and convened nearly 70 individuals representing state hospital associations, pharmacists, health care coalitions, state public health departments, and regional federal partners.

The initial purpose of the working group was to gather information and create situational awareness on the effects of the shortage. However, as more information became available about the extent of the IV fluid shortage, the working group realized that it needed actionable data and guidance as well as advocacy for its partner organizations with both manufacturers and federal partners. The convening of the working group helped to facilitate such advocacy by bringing the right people to the table at the right time.

To assist with response efforts being conducted by the working group, the R7DHRE created a webpage (https://www.regionviidhre.com/iv-fluid) to serve as a source of quick and near real-time information and resources for its partner organizations. This page provided situational updates from Baxter International Inc., the American Hospital Association, ASPR, FDA, and others in addition to resources to help facilities navigate the IV fluid shortage. The page was updated daily as information was released from Baxter and federal organizations to create a central information hub.

A quick and comprehensive resource developed by the R7DHRE’s parent organization, Nebraska Medicine was an excel spreadsheet that allowed facilities to calculate their burn rate of the varied IV fluids so hospitals and health systems could see the demand for each product and the effects of their conservation efforts in real time. This resource was made available early on and allowed facilities to get a better picture of where they stood with their IV fluid supply vs. where they needed to be given the constraints of the shortage.

In conjunction with their partner organizations, the R7DHRE also created a series of clinical recommendations (best practice ideas, standard operating procedures, links to related evidence, etc.) in a downloadable PDF which was updated routinely and posted to the page to be accessible to anyone. From the time of the page’s creation to January 13, 2025, when the working group held its final meeting, the webpage was viewed over 2,600 times.

During the time that the working group met, it helped to coordinate situational awareness, convene subject matter experts, communicate clinical guidelines, and even facilitate the transfer of products between facilities. The IV Supply Disruption work group continued to meet until mid-January, at which time the situation had stabilized enough that an active response was no longer needed.

To assess the impact of R7DHRE’s technical assistance and to inform future response efforts, the workgroup completed a short, anonymous survey. Overall, results indicated that the technical assistance efforts were highly effective, with the majority of respondents strongly agreeing that it provided critical support, advanced awareness, and facilitated a more effective and coordinated response (see graph below).

When asked about the most helpful aspect of the R7DHRE support in response to the IV fluid shortage, work group participants had this to say:

“The R7DHRE backing of contingency and crisis standard of care strategies in the absence of state support or endorsement of these strategies [was most helpful]. The hours of legwork and SME details that go into supply chain shortages! As an association and HCC I have access to those individuals but cannot fund their time and work. They are often embroiled in their own response and do not have capacity to perform the work in the timeframe needed.”  - State Hospital Association Representative

“The most helpful aspect for me was two-fold. 1. Getting to hear from everyone regarding mitigation strategy ideas. 2. When a lot of federal level calls were happening in quick succession, I really appreciated coming back to a trusted group of individuals and getting reports from those calls I couldn't be on.”-Health Care Coalition Representative

The lessons learned, partnerships built, and resources created during the response to the IV fluid shortage will inform future efforts of the R7DHRE as they continue to serve as a convener, advance capabilities in response, and move towards a more prepared healthcare system in HHS Region 7.

When speaking of the R7DHRE’s role in the response, Executive Director, Shelly Schwedhelm stated, “Our ability to serve as a convener of subject matter experts quickly and serve as a source of truth for our regional partners to take action in a time of crisis was very rewarding.”