The study analyzes the impact of Hurricane Maria on the supply chain of saline (0.9% NaCl), which is roughly half produced in Puerto Rico for the US. This hurricane caused shortages at the University of Pittsburgh Medical Center (UPMC), where hospitals used a "just-in-time" model. The study ran for 18 months using mixed methods, including an analysis of IV fluid demand before, during, and after the hurricane, three months of participant observation, and a survey. Adaptive measures included scheduling in operating rooms, standardization in pharmacies, alternative compounding and substitution of drugs, and reliance on other crystalloids. These steps at the system, organizational and individual levels ensured the continuation of anesthetic practice. The findings offer resilience models for future healthcare crises.