AMA Journal of Ethics^®

Abstract

In 2017, Hurricane Maria devastated Puerto Rico and prompted a shortage of normal saline in US health care organizations. This graphic narrative considers ethics and justice in the supply, demand, and allocation of intravenous fluids in clinical settings during this time.

 

Figure. “Normal” Saline: Shortage, Supply, and Solutions

Media

Marker and pencil on printing and tracing paper.

In 2017 and 2018, more than 40 critical medications were in short supply following destruction of drug manufacturing plants in Puerto Rico by Hurricane Maria.¹ In response, government agencies, clinicians, and health care organizations coordinated intravenous fluid allocation to US-based clinical settings. This crisis illuminated the need for researching saline conservation and triage protocols and for diversifying medication suppliers’ manufacturing sites.