Storm damage shuts down NC factories that provide vital hospital supplies

As the remnants of Hurricane Helen 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 just before the worst of the storm passed, according to social media posts from employees. It is now closed and covered in mud – much like western North Carolina. Bridges leading to the facility were also severely damaged.

The Food and Drug Administration said the facility is one of the nation's largest suppliers of IV fluids. Baxter said it would 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.”

Plant shutdowns, which could last weeks or even months based on similar situations in the past, could strain the supply of essential healthcare products.

“The kind of things that are made in this factory are medicines that we are using every day. And especially with sodium chloride, potentially for every patient,” said Dr. Alison Haddock, president of the American College of Emergency Physicians.

IV fluids, such as sterile water, saline, and carbohydrate-containing fluids, are used all the time in hospitals, surgery centers, nursing homes, and dialysis centers. Some medications must be given through IV fluids. And sometimes emergency room patients who need surgery can't have anything in their mouths when they're being evaluated, so they'll get an IV to stay hydrated.

“It's the rare patient in the emergency department that doesn't end up with some IV fluids during their evaluation and treatment, no matter what their chief complaint is,” Haddock says.

Baxter and Govt

The company says work has begun to reopen the factory, employing about 500 people. “We expect this number to double next week.”

The FDA is also working with Baxter and other parts of the government to address the situation. The agency said 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 ensure that existing supplies of IV solutions are evenly distributed.

“My hospital has been told we can expect 40% of what we normally order,” Chris Laman, vice president of strategy at Columbia Memorial Hospital in Astoria, Ore., told NPR in an email. “We're talking about limiting elective surgery.”

Baxter also sent a letter to hospitals suggesting they reevaluate their protocols for IV fluids to make sure they're going to people who really need them and aren't going to waste.

How are hospitals handling the situation?

It is difficult for hospitals to stock IV fluids, as they might with pills or vials of medicine, because IV fluids are bulky. Each liter bag weighs over 2 pounds.

“They're big,” says Michael Ganio of the American Society of Health Systems Pharmacists. “And so hospitals, if they manage inventory on site, there's only so much they can keep on hand at one time. And it depends on what specific solution we're talking about.” Could be a week to 10 days worth.”

He says hospitals are already digging out old policies from when Hurricane Maria crippled a factory making a similar product in 2017.

For better or worse, hospital pharmacists have been through this before.

“It's good because we can manage it,” Ganio said. “We can provide care to patients without affecting patient care. It's bad because it means we're just managing it. We recognize that this is the status quo, and patients are not learning about it.”

What to expect if you are a patient

Most of the juggling happens behind the scenes. Patients likely won't even realize that IV fluid supplies are lacking unless things are really dire. Hopefully the FDA and the healthcare system can prevent this from happening.

But the deficiency can affect emergency room patients who come in with nausea and vomiting, for example.

Often, they will be given an IV bag for hydration. But with a limited supply of these bags, these patients may be given anti-nausea medication and asked to drink a Gatorade or Pedialyte instead. It stores IV bags for intensive care unit patients and those undergoing surgery.

It can become a difficult situation, but patients should know they're in good hands, says Haddock of the American College of Emergency Physicians. “We're professionals at this, and we're going to figure out how to get the care you need, even if it's not the easiest way.”