Introduction: The intensive care unit is a high-resource environment caring for the most critically ill patients that often runs at near or full capacity during regular activity. There is a need to understand how ICU staff navigate the surge in healthcare demand, in a country with a traditionally low disaster preparedness, during a real-time of near-disaster. Methods: Semi-structured interviews were conducted with a strategic sample of eleven ICU staff members from three hospitals in Stockholm, Sweden (anesthesiologists, specialist nurses, nurse assistants) who worked during a state of near disaster in 2020. The interviews were analyzed using qualitative content analysis. Results: Three main categories were identified: organizational level, team level, and individual level. Challenges of rapid expansion, insufficient supplies, and unfamiliarity with equipment were described. Inconsistencies in staff continuity and training in crisis were identified. Moral distress was described due to the overwhelming situation. The importance of the voluntary nature of an emergency contract was emphasized to maintain staff morale and trust in management. The flow of creativity was described. Hierarchy and prestige within the teams could disappear. Over time, the ICU staff became leaders, delegating and educating in the ICU. Experience with excessive work hours, wearing military gas masks was gained. Conclusion: Our findings indicate that in situations of near disaster, local leadership should focus on physical presence, clear communication, and staff well-being. Hospitals may consider a balanced approach that integrates hierarchical decision-making with the skills and knowledge of frontline staff. Customized mental health programs should be prepared to be activated, and methods for the fast integration of new ICU staff without prior ICU knowledge need to be developed. When standard health care can no longer be provided, regional leadership should consider activating the disaster mode.
Günther et al. (Sun,) studied this question.