Beyond Capacity: Resilience of Intensive Care Staff During the COVID-19-Related Near-Disaster in Sweden

Abstract

Background: Intensive care units (ICUs) often operate near full capacity, limiting flexibility during crises. As geopolitical instability increases in Europe, healthcare systems must be prepared to expand and adapt under extreme pressure.

Aim: To explore how ICU staff in Sweden-a country with traditionally low disaster preparedness-managed a near-disaster situation and identify lessons for future crises.

Study design: A qualitative descriptive study using semi-structured interviews and inductive content analysis. Eleven ICU staff members (anaesthesiologists, ICU nurses and nurse assistants) from three Stockholm hospitals were interviewed about their experiences during the 2020 COVID-19 surge.

Results: Three main domains emerged: organisational, team and individual levels. Participants described chaotic ICU expansions, limited supplies and unfamiliar equipment. Inconsistent staff continuity and lack of onboarding for redeployed personnel created stress and hindered care. Moral distress was widespread, fuelled by an overwhelming workload and poor recovery conditions. A voluntary emergency contract helped maintain staffing levels and morale. ICU staff took on leadership roles, educated peers and created ad hoc systems to manage extreme conditions-sometimes while wearing military-grade gas masks. While peer support strengthened team cohesion, feelings of isolation and professional fragmentation also emerged.

Conclusions: Near-disaster conditions require visible local leadership, clear communication and a governance model that integrates frontline expertise. Rapid onboarding, scalable mental health support and clearly defined disaster activation protocols are key to system resilience.

Relevance to clinical practice: ICU staff must be equipped to lead in crisis. Empowering experienced personnel to guide redeployed teams, ensuring rest and recovery opportunities and supporting staff psychologically can mitigate long-term harm. This study provides practical insights for near-disaster preparedness in high-income, low-readiness settings and supports the development of ICU protocols that balance hierarchical leadership with clinical agility.

Keywords: disaster; intensive care unit; moral distress; organisational adaptation.