HLTH 4203 Module 5 Global Supply Chain Analysis Example

One Flooded Plant, Every Ambulance in the County: What the 2024 IV Fluid Shortage Taught a Local EMS Service About Global Supply Chains and Health Administration

Student Name

American College of Education

HLTH4203: Introduction to Healthcare Administration

Module 5 Assignment

Instructor Name

November 2, 2026

A Local Shortage With a Distant Cause

Globalization in health care is often discussed in terms of medical tourism, international recruitment or the spread of disease. For a small ambulance service, it showed up in a supply room. In September 2024, Hurricane Helene made the Baxter Healthcare facility in North Carolina inoperable, halting production at one of the country's leading suppliers of intravenous fluid and disrupting supply across the United States (Mikulas et al., 2025). Hospitals across the country felt the shortage; at one academic health system, pharmacists directed providers to reserve it for emergencies, and clinicians turned to oral rehydration where they safely could.

Our composite county ambulance service carries IV fluids on every paramedic unit. Within two weeks of the storm, our distributor cut our standing order by half and could not say when full deliveries would resume. A plant six hundred miles away, which none of us had heard of, suddenly decided how many bags of saline our crews could carry. This paper uses that experience to examine how global and national supply chains shape health administration and what a local administrator can do about forces far outside the organization's control.

How the Supply Chain Became Fragile

The shortage exposed three features of the medical supply chain that administrators rarely see until it fails. The first is concentration: a large share of a basic product came from a single site, so one disaster could affect the whole country. The second is thin margins: IV solutions are inexpensive, low-profit products, which gives manufacturers little incentive to build spare capacity or second plants. The third is just-in-time inventory: hospitals and EMS services, like most businesses, keep small stocks and rely on frequent deliveries, which saves money in normal times and leaves little cushion when deliveries stop.

These features are connected to globalization even when a product is made domestically. Manufacturers source raw materials, plastics and components from global suppliers, and many other sterile injectable products that ambulances carry are made abroad. The ASHP guidelines on managing drug shortages note that shortages arise from manufacturing problems, supply disruptions and market decisions, and they recommend that organizations prepare with a defined process for assessing and responding to each shortage rather than improvising (Fox & McLaughlin, 2018). Our service had no such process for IV fluids, because nobody expected saline to run short.

What the Service Did

The service's response was improvised but reasonable. The medical director issued a temporary protocol limiting IV fluid to patients with signs of shock, severe dehydration or specific medications requiring a carrier line, and encouraging saline locks, which provide IV access without running fluid, for other patients. Supervisors counted and redistributed stock daily so that no unit ran out while another had surplus. The service coordinated with the two receiving hospitals, which faced the same shortage, to avoid transporting patients whose only need was IV fluid for mild dehydration when oral fluids were appropriate. Aguero and Allen (2024) offer a hospital pharmacy commentary on the same shortage, and the problems it raised for hospitals mirrored ours on a larger scale.

Two problems emerged. The service had no central record of IV fluid use by call type, so the medical director set the conservation rules without knowing how much each category of patient used. And crews learned of the protocol through an email that some did not read before their next shift.

Lessons for Health Administration

The shortage offers three lessons that reach beyond one product. First, an administrator cannot control global supply chains but can map the organization's exposure to them. Our service carries about 140 medications and supplies; for each, the administrator should know the main manufacturer, whether an alternative exists and how many days of stock are on hand. Second, resilience costs money. Holding thirty days of critical fluids instead of seven would have cost the service about $6,000 more in inventory, a small price compared with the risk, but it must be budgeted deliberately because it never appears as a saving. Third, shortages are clinical and administrative at once. The conservation protocol was a clinical decision, but its success depended on administrative systems: inventory counts, communication with crews and coordination with hospitals.

What Policy Can and Cannot Do

Local preparedness is necessary but not sufficient, because the causes of fragility sit at the national and global level. A national committee that studied the security of the country's medical product supply chains concluded that the problem is structural rather than occasional, and it called for greater transparency about where products and their ingredients are made, for purchasing practices that reward reliable manufacturers rather than only the lowest price, and for coordinated planning between government and industry (National Academies of Sciences, Engineering, and Medicine, 2022). The report's central point for administrators is that buyers are part of the problem: when every hospital and ambulance service chooses the cheapest supplier, the market pays no one to hold spare capacity.

A small ambulance service has little purchasing power alone, but it is not powerless. It buys through a regional purchasing cooperative with other EMS agencies and hospitals, and the cooperative can ask distributors to disclose the manufacturing sites for critical products and can weigh reliability in its contracts. Our service will raise both requests at the cooperative's next meeting. It can also report shortages it experiences to the FDA, which uses such reports to identify emerging problems. And it can share its critical supply list with the two receiving hospitals, so that the three organizations know which products each depends on and can agree in advance how to lend stock to one another during the next disruption instead of negotiating by phone in the middle of it. None of this will prevent the next hurricane from reaching a factory, but it moves a small organization from simply absorbing disruptions toward helping to reduce them.

A Preparedness Plan

The service will adopt a shortage preparedness plan with four parts. It will build a critical supply list of the 25 items without which crews cannot treat life-threatening conditions, with the manufacturer, alternative products and target days of stock for each. It will set a trigger: when a distributor reduces an order for a critical item by 25% or more, the operations manager convenes the medical director, a supervisor and the supply coordinator within 48 hours, following the kind of structured process the ASHP guidelines describe. It will communicate protocol changes through a mandatory acknowledgment in the crew scheduling system rather than by email. And it will track use of critical supplies by call type in the electronic patient care record, so that future conservation rules rest on data.

Globalization will keep producing disruptions that begin far from the county: storms, factory recalls, trade disputes or pandemics. A small organization cannot prevent them, but it can decide in advance how it will recognize them early and respond without improvising.

References

Aguero, D., & Allen, D. (2024). Weathering the storm: Commentary on the Hurricane Helene IV fluid shortage. The Journal of Pediatric Pharmacology and Therapeutics, 29(6), 667-669. https://doi.org/10.5863/1551-6776-29.6.667

Fox, E. R., & McLaughlin, M. M. (2018). ASHP guidelines on managing drug product shortages. American Journal of Health-System Pharmacy, 75(21), 1742-1750. https://doi.org/10.2146/ajhp180441

Mikulas, C., Patel, K., Rai, O., Couto Barbosa, E., & Mars, R. L. (2025). Returning to the basics: Embracing oral rehydration therapy during an intravenous fluid shortage after Hurricane Helene. Cureus, 17(3), Article e80146. https://doi.org/10.7759/cureus.80146

National Academies of Sciences, Engineering, and Medicine. (2022). Building resilience into the nation's medical product supply chains. The National Academies Press. https://doi.org/10.17226/26420