CIRCLEVILLE, OH (WCMH) — Four months after Hurricane Maria pummeled Puerto Rico, medical supply shortages are taking a toll on small local fire departments.

The Circleville Fire department was nearly out of IV bags according to a spokesman, until a temporary solution was found.

Saline solution is almost exclusively manufactured in Puerto Rico. It was also used by EMS in most medical emergencies, before the shortage.

Now the shortage of saline in IV bags, epinephrine, dextrose and lidocaine drips are forcing fire departments to come up with ways of thinking outside the box to get supplies.

“There was a lot of times we thought we were going to be completely out, although we have found ways to extend our supplies and we are being very conservative with them,” said Capt. Aaron Kerns, with Circleville Fire Department.

Circleville Fire has two firehouses and 15 full-time and four part-time firefighters and Kerns said the city cannot afford to stockpile medical supplies like larger departments.

This leaves smaller departments like them between a rock and a hard place trying to have enough IV bags for emergencies.

“We are unable to resupply from the hospitals. Matter fact the hospitals have been impacted by this also,” Capt. Kerns, said.

A Spokesman for Berger Hospital in Circleville said they are dealing with the same shortages. He said the hospital is being smart about how and when they use IV bags.

In a previous article by NBC4, Curt Passafume Jr., Vice President at OhioHealth Pharmacy Services said, “I can tell you I have been in this business nearly 40 years and this is really unprecedented! I have not seen a confluence of circumstances like we are seeing right now, and that is causing us to take a step back and really rethink what we are doing here.”

Bigger fire departments and hospital systems are able to stockpile IV bags and some are changing some protocols for which patients receive an IV when they are brought to the emergency room.

Captain Kerns said saline is a must for traumas and dehydration cases in their city of 14,000 people, but they too are being careful when it is used otherwise.

“We were close to being out, we were down to one 1000 cc bag,” Kerns said.

That was before Governor John Kasich and the Ohio Pharmacy Board just stepped up and changed the rules on sales of these types of medical supplies. The State Board of Pharmacy is now allowing fire departments to sell saline wholesale to other fire departments under specific conditions.

Circleville Fire purchased one box of saline, but Kerns said depending on the number of flu cases and emergency runs they could quickly go through their supply.