October 11, 2024

Welcome back to UH EMS-I’s Pharmacy Phriday. 

In this special installment we want to review the effects Hurricanes Helene and Milton have had on our systems locally and discuss the current recommendations shared by our Medical Directors.

As a result of Hurricane Helene and damage suffered at a Baxter plant in North Carolina a supply chain disruption has occurred involving several products including IV fluids. Baxter, along with various government agencies and other producers have been working to limit the disruptions. However, in the meantime product conservation strategies have been recommended nationwide.

Utilizing lessons learned from previous shortages, conservation strategies and protocols are being implemented in hospitals that will not compromise patient care. Pre-hospital providers are being asked to join in these efforts. A recent communication from our Medical Directors group shared some of these efforts and recommendations.

• Limit the use of IV fluids for patients clinically requiring fluid replacement.

• Consider the use of alternate routes for medications other than IV or IO routes. Many medications have various routes that we may utilize outside of IV administration. The protocol lists IV, IO, IM, IN, and PO as various routes. Examples of this include Solumedrol being administered IM or Fentanyl being given IM or IN. 

In cases where medication administration is required via the IV route but does not require fluids, consider a Saline lock.

Even when using a Saline lock, conserve the use of the Saline flushes by saving any unused portion for that same patient.

• In cases of pre-hospital shock the provider should not withhold IV fluids. The standard of care should not be changed because of these recommendations. Follow the protocol and use the IV fluids appropriately.

• Protocol changes are not being made at this time, but certain routes may be added for certain medications as this event unfolds. Just in time training will be shared with providers as any changes or additional recommendations are made.

Hopefully these shortages will be short lived. Lessons learned from prior hurricane disasters and shortages are being considered and implemented at this time in an effort to reduce the impact of these shortages until such a time as the supply chain normalizes. Thank you for your assistance in introducing these product conservation strategies.

Remember that patient care is our primary concern and the standard of care is not changed because of these recommendations. And of course we ask that you remember all those affected by Hurricanes Helene and Milton in your thoughts and prayers.

Till our next installment stay safe!

Sincerely, 

The UH EMS-I Team 

University Hospitals