The Biden administration is rushing to evacuate bags of intravenous fluids from a Florida distribution center in an attempt to insulate the nation’s supply chain from yet another monster storm.
The center in Daytona Beach produces about 23 percent of the country’s IV fluids — and it’s in the path of incoming Hurricane Milton.
Hospitals across the country are already treating patients without their usual allocation of the hydration solutions after Hurricane Helene damaged another factory that supplies some 60 percent of the nation’s IV fluids and specialty solutions used in dialysis. The hit to Baxter International’s Marion, North Carolina, plant forced some hospitals to postpone surgeries and others to rely on Gatorade to rehydrate patients they might otherwise treat intravenously.
“At this point, any further decline of the amount of IV fluids or peritoneal dialysis fluids available is concerning,” said Nancy Foster, vice president for quality and safety policy for the American Hospital Association. The trade association sent a letter to President Joe Biden on Monday afternoon asking that the administration declare an official shortage of sterile IV solutions and allow regulatory exemptions that would help boost supplies.
Hurricane Milton threatens to exacerbate the situation.
The massive storm is set to make landfall Wednesday night, with much of Central Florida under hurricane and flood warnings. That includes Volusia County, home to Daytona Beach, which has enacted evacuation orders for those living in manufactured and mobile homes, as well as low-lying areas and areas prone to flooding.
Milton, which rapidly intensified to a Category 5 storm in a matter of days, is expected to bring more than 10 inches of rain to Daytona Beach. The National Weather Service has warned those in the area to “prepare for life-threatening rainfall flooding having possible significant to extensive impacts across the northern portions of east central Florida.”
In the storm’s path is an IV fluid manufacturing plant and distribution center owned by B. Braun Medical. The facilities are “a key part” of the company’s plans to fill the supply gap left by Baxter’s North Carolina plant shutting down, with the aim of ramping up production in the coming weeks, Director of Corporate Communications Alli Longenhagen wrote in an email.
Both facilities are located on properties with flood hazards, according to maps kept by the Federal Emergency Management Agency. The manufacturing plant is located on a particularly flood-prone stretch of road where homes were destroyed by Hurricane Ian in 2022, and that regularly floods in 100-year storms, according to local news reports.
The Department of Health and Human Services’ Administration for Strategic Preparedness and Response (ASPR) has been coordinating with B. Braun “to move their product out of the path of the storm,” said ASPR spokesperson Zachary Dembner.
“ASPR and HHS partners are committed to continue working with public and private partners to support the supply chain as facilities address [their] return to full operational capacity,” he said.
Longenhagen said B. Braun has worked with the federal government to move finished product out of the distribution center “to a secure, temperature-controlled facility north of Florida.”
“We are focused on protecting our people and mitigating the impact of the storm on our IV solutions supply,” she said.
Both the manufacturing plant and the distribution plant will be closed Wednesday with plans to resume operations at both sites at 8 a.m. on Friday morning. IV fluids moved out of Florida during the storm will return to the distribution center to be shipped to customers. The company has already ramped up production at a separate manufacturing plant in Irvine, California, and “will resume this plan at Daytona Beach following Hurricane Milton’s departure,” Longenhagen said.
“We are committed to doing everything we can to help ensure that patients have access to the IV therapies they need,” she said.
‘Not their first rodeo’
B. Braun Medical decided to build its Daytona Beach plant in 2016 to help alleviate ongoing IV fluid shortages.
Intravenous fluids are specially designed liquids that are used to treat and prevent dehydration for patients experiencing all sorts of medical emergencies, as well as those undergoing routine surgeries. Because they are injected directly into a patient’s body, they must be produced in specially designed factories to keep them free of bacteria.
The United States gets its saline from just three companies: Baxter International, B. Braun and ICU Medical, though a fourth manufacturer, Assure Infusions, plans to begin production in January. The consolidated supply has caused shortages in the past, most notably in 2017 after Hurricane Maria took offline another Baxter plant that manufactures the small plastic bags used for IV fluids. That storm also damaged roadways around the plant, which took months to repair.
Bags of IV fluid are heavy, and thus rely on ground transportation to get from manufacturing plants to the hospitals where they can be used to treat patients. That makes the industry especially vulnerable to extreme weather, said Tom Cotter, executive director of the nonprofit Healthcare Ready, which tracks climate change’s impacts on health care.
“Our general infrastructure is not as robust as it needs to be to face these storms,” he said.
That’s part of what happened with Baxter’s manufacturing site in Marion, North Carolina. The manufacturer implemented hurricane preparedness plans that included proactively moving products to higher ground or secure storage where feasible. Even still, the site was “significantly impacted” by rain and storm surge from Hurricane Helene, which also took out county-maintained bridges leading to the plant.
Cotter said one silver lining of the current situation is that hospitals can draw on their 2017 experience in responding to IV fluid shortages.
“It’s not their first rodeo,” he said.
At Massachusetts General Brigham Hospital in Boston, for example, leaders instituted conservation measures they deployed following Hurricane Maria as soon as Baxter notified them that they would only receive 40 percent of their usual shipments of IV fluids.
Chief Preparedness Officer Paul Biddinger said the hospital is now reserving IV fluids for patients who can’t eat or drink on their own, such as those who are undergoing intestinal surgery. Massachusetts General Brigham, which also has locations in Western Massachusetts and New Hampshire, and on Martha’s Vineyard and Nantucket, is still assessing patient needs for other specialty fluids.
Biddinger said the hospital is looking to supplement its current supply with fluids from other manufacturers. But the small number of factories that produce the drugs means companies often can’t boost supply quickly, he said.
“We are very concerned about the impacts of climate change on the supply chain,” he said.
Columbia Memorial Hospital in Oregon is also feeling the squeeze. Vice President for Strategy Chris Laman said his hospital has been trying to conserve IV fluids for the past week. His hospital has a response team that meets three times a week to monitor the hospitals’ IV fluid supplies and that has made a spreadsheet available to all employees who want to track the dwindling supplies in real time.
So far, conservation measures are enough and the hospital hasn’t had to cancel any surgeries, but Laman is worried about the situation turning dire, as it did after Hurricane Maria, when “we did have to change patient care.”
“Over the next couple of weeks, if we don’t start to get more shipments, it will have a significant impact,” he said.
‘Spare no resource’
The federal government is helping Baxter bring its plant back online and improve supply.
As of Monday, a temporary “rock bridge” was installed to allow access to the site, with the North Carolina Department of Transportation working to install a second bridge. The company has also begun removing existing inventory from the site to ship to hospitals, and is working with the Food and Drug Administration to get approval to bring fluids manufactured internationally into the United States.
Baxter now says it expects “to begin communicating anticipated production plans within the next two weeks.” The company has vowed to “spare no resource — human or financial — to restart operations and help ensure patients and providers have the products they need.”
The HHS Administration for Strategic Preparedness and Response (ASPR) is “working to support infrastructure repairs and ensure the facility resumes operations as quickly as possible,” Dembner said.
He said the agency is also “providing technical assistance and support” to increase manufacturing at other sites.
“ASPR is encouraging manufacturers, wholesalers and distributors to evaluate product allocation and health care providers to implement product conservation strategies to maximize available supply,” he said.
Foster, at the American Hospital Association, fears that won’t be enough, noting some members have already started canceling elective surgeries because their supplies are so low.
That’s part of why the association sent a letter to Biden on Monday asking for increased flexibility in using the IV fluids hospitals already have. That includes extending the expiration date of some fluids and allowing hospitals that can mix IV fluids in-house to distribute those fluids to other hospitals within the same system.
“We are asking them to please unleash whatever capabilities hospitals have to help with this situation,” she said.