Many patients arrived at Hawaii's busiest trauma emergency room in pain.
"It could be patient suffering from trauma, injuries from an accident, or an accident of some sort," Dr. Howard Klemmer, Queen's Medical Center ER physician said.
Doctors at the Queen's Medical Center, and others around Hawaii, no longer have a number of common medications to help.
"We're experiencing some shortages with injectable pain medications," Klemmer said.
He added pain medications are important to keep patients out of distress, so they can make rational decisions about their healthcare - instead of only focusing on the pain.
But morphine and other opiate-based medications are especially hard to find, not just in Hawaii, but across the country.
"Some of the injectable medications for blood pressure, heart rate control are also limited," Klemmer said.
Even simple items like saline are in short supply.
Klemmer said the drug shortage is just a nuisance and hasn't affect patient care at Queen's, so far.
He and his ER staff use alternative medications. Different drugs vary in effectiveness, duration and have side effects than doctors and nurses may not be used to seeing. Which gives everyone one more thing to think about, during a life and death emergency.
"It created a level of fear and uncertainty, because we like to able to know what we'll be able to use as resources for patients," Klemmer said.
Part of the reason for the shortage is because Pfizer, the largest manufacturer of generic injectables in the U.S., ran into problems at a number of its plants - including the one that made the Epi-pen. Repeated violations resulted in a drop in production.
"The one that was worrisome to us was the Epi-pen, These are critical medications for people who suffer from anafilaxis," he said.
Now the company has depleted all stocks of certain pain medications and other important drugs. Not only will they be out for the busy summer months, the shortage is expected to stretch into next year.
While periodic drug shortages have happened before, doctors and pharmacists are bringing the issue to light because this time around it has been more drastic.
"I've been practicing emergency medicine for 25 years now, and the last 6-7 years have been the worst that I've ever seen as far as shortages," Klemmer said.
Seven years ago, there were 251 medications listed as in short supply according to the Food and Drug Administration. The number dropped to 50 last year but has doubled since that time. Now there remains a shortage of more than 100 medications.