Nursing Economic$

The MOUNT Model of Student Nurse

Deployment During Times of Disaster
Ann N. Hellman
Shelia Hurley

Nursing schools provide

exceptional opportunities for
hospitals and other organizations
to strengthen resource pools
and decrease costs during times
H ospitals and
community medical
organizations
responding to meet the needs of
their patients and citizens during
resulted in downed power lines
and power poles. Roadways and
highways were obscured by
thousands of downed trees
which resulted in widespread
of disaster. The MOUNT Model times of disaster can face power outages. The Cumberland
facilitates collaboration and extreme cost and immense County Emergency Management
planning among community strain on their operating Agency asserted that it was “the
stakeholders prior to disaster systems, personnel, and worst natural disaster in the
events, resulting in enhanced resources. An often-overlooked history of Cumberland County”
community disaster response. resource in many communities (National Weather Service, 2015,
is a nursing school. Nursing para. 2). The Volunteer Electric
schools provide an exceptional Cooperation reported more than
opportunity for hospitals and 35,000 people without power
community medical and $9.5 million in damage to
organizations to strengthen their the utility infrastructure. Costs of
resource pool and decrease the disaster to the Upper
costs during times of disaster Cumberland Region was
response. By providing students estimated at $1.6 million (“Ice
to increase hospital manpower Storm,” 2016).
reserves, hospitals will have Post-disaster response by a
additional personnel without regional health department, the
increased costs since students public health administration
will not be hourly employees which consisted of the
but will respond to the disaster emergency preparedness/special
episode for clinical credit and needs coordinator and the head
experience. of the local Medical Reserve
Corps located in the regional
Background health office, lasted 3 weeks.
The regional health department
On February 20-21, 2015, recognized the assistance the
Middle Tennessee was school of nursing could have
devastated by an inch of ice provided had a prior agreement
accumulation on top of snow, been in place. The public health
sleet, and ice already on the administrators arrived at this
ground along the Cumberland observation when sheltering
Plateau. Ice accumulation patients, some requiring
extensive medical support,

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during an ice storm with disasters. Challenges discussed Mobilizing

extended power outages. In included high level of
Mobilizing refers to
addition, they provided housing, organization needed, contacting
establishing a method of
food, and childcare. Shelter students when many
mobilizing nursing students
residents included citizens who communication systems are
during times of disaster. From
normally received medical care inoperable, and mobilizing
this component, students can
of various degrees in their safely dependent upon the type
learn how hospitals practice
homes. When arriving at the of disaster.
staff notification and reporting
shelter, these residents often did Although schools and
for duty, phone trees, and use
not have the necessary supplies colleges accredited by the
of social media as a newer
and medical equipment needed American Association of
method of mobilizing response.
for continued care and their Colleges of Nursing (AACN)
primary caregivers often did not follow The Essentials Series To be prepared for future
remain at the shelter with them. which puts forth guidelines for disaster response and to carry
Not only did the regional health curricula development for out the notifying stage of the
department staff have to obtain baccalaureate degrees in nursing model, each class is divided into
such supplies and equipment, and calls for education on teams at the beginning of the
but found their staff was disaster preparation, it is often semester.
unfamiliar with much of the minimally addressed. As faculty Disaster nursing demands
required care and needed began preparing students for adaptation of skills to chaotic
equipment. Administrators future disaster response, a conditions, usually with lack of
recognized that nursing students model of student preparation for facilities and equipment. This
are trained on some of the latest engagement emerged. Use of chaotic situation requires
equipment and, through their this model will enhance AACN- student nurses to learn and
acute care clinical rotations, are accredited schools’ and colleges’ apply leadership skills to
more up-to-date on procedures curricula in the area of disaster manage patients and other
than many of their staff. preparation. students as they work
Additionally, they identified collaboratively with the entire
multiple ways they could have disaster team. According to
MOUNT Model Rafferty-Semon, Jarzembak, and
effectively utilized nursing
students during the disaster such For many nursing educators, Shanholtzer (2017), proficiency
as performing triage, trying to incorporate students in “proper assessment, priority
assessments, and assisting with into true disaster response can recognition, communication,
childcare. seem an insurmountable task. and collaboration skills” enables
This realization became the The MOUNT (Mobilizing, the nurse “to make accurate,
impetus for discussions with the Optimizing, and Utilizing life-altering decisions in highly
local school of nursing and Nursing students Tactically) emergent and demanding
faculty who were trained in Disaster Response Model situations” (para. 3). Thus, full
disaster nursing. Following provides a step-by-step method integration of the MOUNT
multiple discussions over for nursing faculty to provide model enables schools of
approximately 2 months among nursing students the opportunity nursing to further implement
public health administrators, to participate in community students embracing leadership
school of nursing faculty, and disaster response, thereby roles. Student leaders are
the dean examining policies and providing additional resources chosen through a set of criteria:
liabilities of such an endeavor, a and decreasing costs to area faculty recommendation;
memorandum of understanding hospitals and medical healthcare experience prior to
joined the two organizations in organizations. Discussion of entering nursing school such as
preparing for nursing students’ each component of this model paramedic, EMT, etc.; high GPA
response in future community follows. in nursing courses; and

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 Nursing Economic$

demonstrated leadership resuscitation simulation (Chen et clerical duties. Students may be

experience in nursing school al., 2018; Nowak, Fitzpatrick, asked to participate in other
organization positions such as Schmidt, & DeRanieri, 2015). functions including
president, etc. Each team is recordkeeping, communication
assigned a team leader who is Optimizing between response units, support
responsible for facilitating the Optimizing pertains to for patient and family
response process. The team enlisting students in community identification and tracking at
leader is a senior student organizations’ disaster reunification centers, and
chosen by the faculty based on preparation events as much as participation in evacuation
knowledge and experience possible. Having students protocols. Their constant
level. This team leader would participate in community attendance can provide a
assist with delegating emergency management annual reassuring presence for patients
assignments based on the planning events, Medical and family members by making
students’ placements in the Reserve Corps mass medical routine rounds, providing water
curricula and their expected skill dispensing activities, and and snacks to patients and
levels. Remote Area Medical clinics family members, communicating
Mobilizing also includes provide students with the basic emergency plans of action
education. Faculty educate opportunity to see the Incident to members of the community,
students on disaster nursing Command System in use with and assisting with toileting and
through multiple ways. Lecture multiple agencies operating hygiene.
content focusing on types of together. Such systems Nursing students with
disasters, methods of disaster management is inherent in any demonstrated knowledge, skill,
response, and response systems disaster response. Faculty and experience may assume
is provided. Lecture content also networking with such care of noncritical patients
includes leadership roles, chain organizations, offering students under the supervision of faculty
of command, Incident to participate in their events, including staffing relief for
Command System, best seeking out every available nurses to be reassigned to more
communication methods during opportunity for students to disaster-critical areas such as the
disaster such as STARCC practice components of disaster triage area, emergency
(Simple, Timely, Accurate, response, and fostering department, operating room,
Relevant, Credible, Consistent), collaborations with multiple and critical care areas.
and self-care during and community organizations who Following the disaster, students
following disasters. may respond during disasters may assist with follow-up calls
Collaborating with community are integral steps in the MOUNT to those affected by the disaster,
organizations such as the model. participate in the hot wash
Medical Reserve Corps and the (exercise in which all involved
American Red Cross will provide Utilizing Nursing Students in the disaster meet to critique
additional training opportunities. Utilizing nursing students is the effectiveness of disaster
Low and high-fidelity an area that many hospitals and response), and support clean-up
simulations such as tabletop community organizations do not and returning clinical areas to
exercises and bioterrorism adequately appreciate. Nursing states of readiness.
simulations provide hands-on students can be used in a Collaborating with the
application prior to deployment myriad of ways during times of community in time of disaster is
during times of disaster. Nursing disaster response. Novice mutually cost beneficial.
students who were taught students may be used to Facilities have the benefits of
effective disaster triage methods transport patients, assist in food extra staff, both students and
in clinical simulation were preparation for staff breaks, and faculty, at no additional cost.
found to have decreased function as runners for The school of nursing benefits
response time in emergency nonpatient-related tasks such as by having profound clinical

248 September/October 2019 | Volume 37 Number 5

 Nursing Economic$

experiences for the students A key component of this presence of mental health crisis
without a delay in the students education is preparing for the as the victims try to recover
learning during a disastrous mental health impact of disasters from the disaster. Students can
event. on both the victims and on help to restore the hospital units
As costs of disasters are those responding to help. and community organizations to
dependent upon disaster type, Providing students with their regular level of functioning
geographic region, and length information on the signs and by performing inventory counts,
of disaster, cost savings when symptoms of mental health restocking supplies, performing
using the MOUNT model cannot crisis, how to best approach clean up, and tagging
be determined. As stated disaster victims, and referral equipment that may need
previously, the ice storm sources for continued care are maintenance. Additionally,
initiating the public health essential. Practicing disaster students can participate in
administration being interested response techniques through the conversations pertaining to
in partnering with the school of use of tabletop exercises, policy revision which may have
nursing cost the region more participation with community become evident during the
than $1 million (“Ice Storm,” agencies in their events, disaster response.
2016). However, this model notification of staff, and use of
obviously provides added high-fidelity simulations will Conclusion
resources thereby decreasing prepare students to safely
staffing hours and burnout, respond during times of disaster. The MOUNT model
while adding invaluable clinical During the impact phase of encourages collaboration
experience. the disaster, through previous between schools of nursing,
preparation, students will hospitals, and community
Tactically understand how to be activated medical organizations during
Tactically refers to steps for disaster response (type of times of disaster response. Such
taken by all involved throughout disaster, general safety collaboration results in
each phase of the disaster: pre- precautions, Incident Command decreased costs to hospitals and
disaster, impact, and post- System, etc.), their functions medical organizations, additional
disaster. During the pre-disaster performed under the staffing resources, and in some
phase, emphasis is placed on supervision of a licensed nurse cases, students who have more
education and practice. When (either their faculty or an up-to-date training on the latest
preparing to involve students assigned preceptor), and have a medical equipment. Further, this
safely in disaster response, general expectation of their collaboration offers enhanced
students must receive such response role. Students will be clinical experience for students
educational components as utilized in the various roles in leadership roles during
lecture content on types of mentioned previously to aid the disaster, a mechanism to avoid
disasters, methods of disaster response agency (hospital or missed clinical days, and an
response, response systems, community organization) by opportunity for schools to
leadership roles, chain of providing resources and provide service to their
command, Incident Command reducing cost. communities. The MOUNT
System, and self-care. Asking During the post-disaster model facilitates collaboration
students to consider enrolling in period, after students receive and planning among multiple
such organizations as the appropriate education regarding community stakeholders prior to
Medical Reserve Corps ensures follow-up care, they may disaster events, resulting in
they receive the most up-to-date contact victims via phone, text, enhanced community disaster
information from an or email to provide continued response. $
organization that is not only instructions on follow-up care;
continued on page 254
reputable but also has vast provide additional resource
experience in disaster response. contact lists; and assess for

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 The MOUNT Model
continued from page 249

Ann N. Hellman, PhD, MSN, RN

Associate Professor
Tennessee Tech University
Whitson-Hester School of Nursing
Cookeville, TN

Shelia Hurley, PhD, MSN, RN

Associate Professor
Tennessee Tech University
Whitson-Hester School of Nursing
Cookeville, TN

References
Chen, J., Yang, J., Hu, F., Yu, S.H., Yang, B. X., Liu, Q., & Zhu, X. P.
(2018). Standardized simulation-based emergency and intensive
care nursing curriculum to improve nursing students’ performance
during simulated resuscitation: A quasi-experimental study.
Intensive and Critical Care Nursing, 46, 51-56.
Ice storm top story of 2015. (2016). Herald-Citizen. Retrieved from
http://herald-citizen.com/stories/ice-storm-top-story-of-
2015,11496
National Weather Service. (2015). February 20-21, 2015 Historic ice
storm. Retrieved from https://www.weather.gov/ohx/20150221
Nowak, M., Fitzpatrick, J.J., Schmidt, C.K., & DeRanieri, J. (2015).
Community partnerships: Teaching volunteerism, emergency
preparedness and awarding Red Cross certificates in nursing
school curricula. Procedia-Social and Behavioral Sciences, 174,
331-337.
Rafferty-Semon, P., Jarzembak, J., & Shanholtzer, J. (2017).
Simulating complex community disaster preparedness:
Collaboration for point of distribution. The Online Journal of
Issues in Nursing, 22(1).

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Reproduced with permission of copyright owner. Further reproduction
prohibited without permission.