Assessment of hospital surge capacity using the MACSIM simulation system: a pilot study

  • K. Lennquist MontánEmail author
  • L. Riddez
  • S. Lennquist
  • A. C. Olsberg
  • H. Lindberg
  • D. Gryth
  • P. Örtenwall
Original Article



The aim of this study was to use a simulation model developed for the scientific evaluation of methodology in disaster medicine to test surge capacity (SC) in a major hospital responding to a simulated major incident with a scenario copied from a real incident.


The tested hospital was illustrated on a system of magnetic boards, where available resources, staff, and patients treated in the hospital at the time of the test were illustrated. Casualties were illustrated with simulation cards supplying all data required to determine procedures for diagnosis and treatment, which all were connected to real consumption of time and resources.


The first capacity-limiting factor was the number of resuscitation teams that could work parallel in the emergency department (ED). This made it necessary to refer severely injured to other hospitals. At this time, surgery (OR) and intensive care (ICU) had considerable remaining capacity. Thus, the reception of casualties could be restarted when the ED had been cleared. The next limiting factor was lack of ventilators in the ICU, which permanently set the limit for SC. At this time, there was still residual OR capacity. With access to more ventilators, the full surgical capacity of the hospital could have been utilized.


The tested model was evaluated as an accurate tool to determine SC. The results illustrate that SC cannot be determined by testing one single function in the hospital, since all functions interact with each other and different functions can be identified as limiting factors at different times during the response.


Surge capacity Major incident Simulation system Hospital preparedness MACSIM system 



The authors want to express their gratitude to the Management of the Karolinska University Hospital for providing resources for the preparation and performance of this test. We also want to thank all participating staff of the hospital for invaluable support in the preparatory work, professional performance during the test and valuable feedback on the methodology. This study was supported by the Stockholm County Council, Sweden and the Laerdal foundation, Norway (Grant 2908).

Compliance with ethical standards

The authors state compliance with the ethical guidelines in the creating of this manuscript. The preceding inventory of the hospital was done with complete removal of all data connected to individual patients. All staff participated voluntarily.

Conflict of interest

Kristina Lennquist Montán, Louis Riddez, Anna Carin Olsberg, Håkan Lindberg, Dan Gryth and Per Örtenwall declare that they have no conflict of interest. One of the authors, Sten Lennquist, has the copyright for the MACSIM simulation system, developed for scientific and educational purpose. The evaluation of the hospitals capacity and function was done by external observers, also participating as supervisors during the test.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • K. Lennquist Montán
    • 1
    • 7
    • 8
    Email author
  • L. Riddez
    • 2
  • S. Lennquist
    • 3
  • A. C. Olsberg
    • 4
  • H. Lindberg
    • 5
  • D. Gryth
    • 6
  • P. Örtenwall
    • 1
  1. 1.Department of Surgery, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  2. 2.Department of Molecular Medicine and SurgeryKarolinska InstituteSolnaSweden
  3. 3.Department of Surgery (professor emeritus)University of LinköpingLinköpingSweden
  4. 4.Emergency DepartmentKarolinska University HospitalSolnaSweden
  5. 5.Stockholm County CouncilStockholmSweden
  6. 6.Department of Physiology and PharmacologyKarolinska InstituteSolnaSweden
  7. 7.Centre for Prehospital and Disaster MedicineRegionens HusGothenburgSweden
  8. 8.DanderydSweden

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