Hurricane Milton heads towards Florida

The National Hurricane Center on Monday announced that Milton had intensified to a Category 5 hurricane, with maximum sustained winds of 175 mph.

According to the National Weather Service (NWS), Milton is expected to drop to a Category 3 hurricane by the time it makes landfall near Tampa, which is still "a very large and powerful hurricane … with life-threatening hazards at the coastline and well inland," NWS warned.

While Milton is already a strong storm, the short turnaround after Hurricane Helene has state officials concerned that saturated groundwater, strained infrastructure, and uncleared debris could make damage even worse.

"That creates a huge hazard," said Florida Gov. Ron DeSantis (R), who signed a state of emergency declaration for 51 counties in the state.

"The challenge as a result of Helene is that those areas that are likely to be significantly impacted by Milton are still contending with debris everywhere, the sand and other debris clogging drains," said Mary Mayhew, president and CEO of the Florida Hospital Association. "Milton is forecasted to have a significant surge along the coast and a volume of rain, so the vulnerability to extreme flooding is significant."

In preparation for the hurricane, HHS Secretary Xavier Becerra declared a public health emergency in Florida on Tuesday, which allows healthcare providers and suppliers to address emergency health needs more easily.

"We are working closely with state and local health authorities, as well as our partners across the federal government, and stand ready to provide additional public health and medical support," Becerra said.

How hospitals are preparing for Hurricane Milton

As of Tuesday evening, 313 healthcare sites have reported evacuations in Florida, including 179 assisted living facilities, 63 nursing homes, and 17 hospitals, according to a release from Gov. DeSantis's office.

Lee Health CEO Larry Antonucci said lessons he learned from Hurricane Ian in 2022 are shaping the hospital chain's preparations for Milton.

Lee Health and its pharmacies intend to remain open during the storm. During Hurricane Ian, flooding in hospital parking lots destroyed around 400 cars, so staffers have been encouraged to get rides or use Lyft rides paid for by Lee Health to get to work, Antonucci said. The hospitals have also secured water tanks to flush toilets and keep their chiller systems working.

Meanwhile, AdventHealth Florida president and CEO Randy Haffner said in a statement that the health system is "as prepared as we can be with water, generators, sandbags, satellite phones, and the best caregivers there are. We are paying close attention to the storm surge."

Tampa General Hospital (TGH) said it has stocked more than five days' worth of supplies at its facilities and intends to keep some trained staff onsite during the storm. TGH also moved more than 5,000 gallons of water to its campus on Davis Islands to support operations and built an AquaFence barrier to protect certain areas from flooding.

University of Florida Health said Monday that most of its hospitals, outpatient clinical facilities, and physician practices will remain open with some exceptions.

Other health systems are temporarily closing inpatient and outpatient sites through at least Thursday. HCA Florida has closed five hospitals and a freestanding ED in Cape Coral and is transferring patients to other Florida facilities. A spokesperson for HCA didn't provide a timeline for when the facilities will reopen, but said they will stay closed until it's safe to reopen. The spokesperson added that around 200 HCA employees are overseeing the disaster response.

BayCare Health System is evacuating Morton Plant North Bay Hospital and will temporarily close its Bardmoor ED at noon on Wednesday. As of Tuesday, BayCare had discharged almost 150 patients, including 91 transferred to other facilities. All BayCare ambulatory care sites, behavioral health outpatient locations, and BayCare Medical Group practices will be closed Wednesday and Thursday.

A spokesperson for BayCare said state officials have asked to use a former Barnes & Noble building in Tampa recently purchased by BayCare as an emergency shelter. BayCare is also working with health officials to transition the former South Florida Baptist Hospital in Plant City into a recovery efforts site.

In addition, the James A. Haley Veterans' Hospital in Tampa, which is affiliated with the University of South Florida Morsani College of Medicine, announced the hospital and its outpatient clinics will be closed for in-person appointments and elective surgeries through Thursday.

Many other hospitals have also paused elective procedures. Orlando Health canceled elective procedures Wednesday and Thursday at its Bayfront Hospital in St. Petersburg and is asking pregnant women near their due date to not come into Bayfront's Center for Women and Babies unless it's a medical emergency.

Hurricane Milton's potential effect on IV solutions

Hurricane Milton could also have a significant effect on supplies of IV solutions across the United States.

Last week, Baxter International's IV fluid manufacturing facility in Marion, North Carolina, was temporarily shut down following Hurricane Helene. The facility supplied around 60% of the IV solution used by hospitals in the United States every day, The Hill reports.

Nancy Foster, VP for quality and patient safety policy at the American Hospital Association, said that hospitals nationwide that rely on Baxter have been told to only expect 40% of their normal shipments. "And that's all that will be available to them until the situation begins to improve," she said.

This means hospitals will have to think conservatively in how they use IV fluids, Foster said, prioritizing certain patients who "absolutely need" those solutions and using alternate methods for others.

Foster said that 17 different products were manufactured at Baxter's North Carolina facility, including different types of saline, as well as ringer's lactate, which supports patients' bodily function.

Hurricane Milton has the potential to make the situation worse, as B. Braun, another major IV solution manufacturer, has a facility in Daytona Beach, Florida.

A spokesperson for the Administration for Strategic Preparedness and Response (ASPR) said it is coordinating with B. Braun "to move their product out of the path of the storm and facilitate other activities that will mitigate potential impacts on future distribution."

B. Braun is closing its Florida manufacturing plant and distribution center on Wednesday and plans to resume operations on Friday, Oct. 11.

Alli Longenhagen, director of corporate communications at B. Braun, said the company is working with ASPR to transfer its inventory in Florida to a "secure, temperature-controlled facility, north of Florida." After the storm passes, the product will then return to the distribution center, she added.

"The Daytona Beach facility is a key part of our plan to help address the shutdown of Baxter's IV solutions manufacturing facility in North Carolina," Longenhagen said. "In partnership with ASPR, we are taking immediate steps to increase production of critical IV fluids at our plant in Irvine, CA, and will resume this plan at Daytona Beach following Hurricane Milton's departure." (Hudson et al., Modern Healthcare, 10/9; Kekatos, ABC News, 10/7; Muoio, Fierce Healthcare, 10/8; Choi, The Hill, 10/9; Malhi/Beard, "Health Brief," Washington Post, 10/9)