Investigating Nationwide IV Shortages After Hurricane Helene

Intravenous fluid (IV) use in pediatric emergency departments decreased nationwide following Hurricane Helene, according to a recent study published in JAMA Pediatrics, findings that may help emergency departments identify opportunities to improve future care delivery and resource allocation.

Sriram Ramgopal, MD, assistant professor of Pediatrics in the Division of Emergency Medicine, was senior author of the study.

On September 29, 2024, Hurricane Helene damaged one of the largest IV fluid manufacturing plants in the U.S., causing a national IV fluid shortage as was reported by the FDA. At the time, there was no clear indication as to when the shortage would end and the FDA issued guidance urging hospitals to conserve IV fluid use.

While IV fluids are provided to pediatric patients with numerous conditions, including severe dehydration, sepsis and post-surgery care, historically they have also been overused in patients for reasons that may not be related to their true medical needs, according to Ramgopal.

“IV fluids are easy to order, they’re abundantly available and oftentimes we give them to patients without a true need,” Ramgopal said.  “When this hurricane struck, there was a need to reconcile patients who really needed IV fluids with those for whom IV fluids were perhaps used unnecessarily.”

In the current study, Ramgopal and his team aimed to identify changes in IV fluid use and clinical outcomes in children and adult patients cared for in U.S. emergency departments following Hurricane Helene.

Specifically, the investigators studied trends in emergency encounters for children between August 1 and December 15, 2024, from 42 pediatric hospitals in the Pediatric Health Information System database, and identified more than one million pediatric emergency department encounters and three time periods: pre-intravenous fluid shortage (before October 4, 2024), early shortage (October 4 to 24, 2024), and late shortage (after October 24, 2024).

In the early shortage period, they found that intravenous fluid use during emergency department encounters decreased from 12.8 percent to 10.2 percent.

“It was a pretty dramatic drop. We’re talking about all patients that come to the ED. While an almost 3 percent drop sounds like a small number, it’s actually a lot of patients,” Ramgopal said.

During the early shortage period, the investigators also saw a small increase in return pediatric emergency department visits, but no substantial change in unscheduled return visits that led to hospitalization. They also saw a decrease in laboratory testing during this time period.

During the late shortage period, or after October 24, 2024, the investigators found that IV fluid use slowly began to increase.

These findings, according to Ramgopal, could ultimately help U.S. emergency departments be more proactive in developing robust, multi-stakeholder approaches that maximize the benefit of IV fluids and other essential resources while also minimizing patient harm.

“I think it does show how things are going to be okay in the setting of some stress on resources as long as people are proactive approaches as to how we are going to manage the shortage moving forward,” Ramgopal said. “Thinking about things from a more cost-conscious or resource-conscious way is really important for us as a community of physicians to do.”

This work was supported by Agency for Healthcare Research and Quality grant 5T32HS000063 and National Institutes of Health grants K23HL173694, K23HD112548 and 5K01HL169921.