psb t echniques & p rocedures for r ad /n uc d isaster r esponse

PSB TECHNIQUES &

PROCEDURES FOR

RAD/NUC DISASTER

RESPONSE

VIDEO CLIP

Click anywhere in frame above to view the videoExcerpt from Psychological First Aid in Radiological (or Radiation)

Disasters courtesy of Center for Disease Control and Prevention (CDC)

PSB TECHNIQUES AND PROCEDURES

FOR RAD/NUC RESPONSE

● Rapid assessment, triage, & stabilization (R.A.T.S.)

● Psychological First Aid (PFA)

● Risk communication

● Conflict resolution

R.A.T.S.

Presenting Problems:

● Aggression: Can the person control violent impulses?

● Disruptiveness: Can the person regain composure and consider needs of others?

● Self harm: Does the person have active suicidal intent or exhibit behaviors involving potential risk of self harm?

● Anguish: Is the person inconsolable?

● Mental status: Does the person show confusion, psychosis?

RAPID ASSESSMENT, TRIAGE, & STABILIZATION

Acute phase rapid assessment activities:

● Talk with the person: get information, observe- Allow the individual to tell you what is going on

● Model a calm demeanor

● Reflect understanding

● Problem-solve

● Proceed to deciding the person’s triage status


Deciding the person’s triage status:

● Resolved after talking

● Apply de-escalation procedures

● Remove to safety/quiet area

● Seek medical/psychiatric opinion

● Call Security


Rapid stabilization (and de-escalation if needed):

● May be needed for people so acutely distressed that they:- cannot function- are disruptive to others- present a direct threat to their own or others’ safety

● Strong and overwhelming emotions are often brief in duration- Give the person a few minutes of privacy to process cognitive overload and calm down – may allow episode to blow over

- Tend to some nearby business, telling the person you will be available and will check back shortly to offer help


If possible, separate disruptive individuals to a quieter place

Enlist calm family/friends to comfort distressed individuals

Main interventions for acute situations:- Offer support- Focus on manageable and immediate concerns- Offer distracting and grounding techniques

For very agitated individuals:- Approach calmly; invite calm discussion- Establish orientation (is the person confused/disoriented?)- Offer specific choices (behave calmly/seek higher level of assistance

For anyone contemplating harm to self or others or who appears unable to control such urges, seek security and/or medical assistance immediately.

Do not leave the person unsupervised.


Initiation of crowd behaviors:

1) Seed: individual or small group who begins divergent activity that entices others to join in

2) Crowd engagement: others engage in the seed activities, producing the crowd behavior

Examples:● Human waves at sporting events (harmless behavior)● Stampedes started by a few people pushing (harmful behavior)

DYNAMICS OF CROWD BEHAVIORS

Zeitz et al 2009 Prehosp Dis Med 24:32-8

● Restriction of the flow of people produces physical pressure points in crowds- eg, bottleneck at entrances and exits for major crowd events

● "Flight" response to a threat (either real or perceived)- eg, crowd fleeing a bomb scare

● Craze: a competitive rush to gain a highly valued goal- eg, physical competition to gain access to limited supply of

life-saving antidotesFruin 1971, Pedestrian Planning and Design, Metropol

Assn Urb Designers Envir Planners, New York

CROWD BEHAVIOR FLASHPOINTS

Assessing and managing crowd behavior:1) Assess & monitor ongoing behaviors

- Warning signs: noise level (shouting), cursing, agitation (pushing, shoving, running), threats, aggression

2) Manage seed behavior- Remove negative seeds (eg, redirect to a quiet location to de-escalate)- Generate positive seeds (eg, get a group to start singing pleasant songs)

3) Inhibit harmful crowd engagement- Redirect crowd attention to positive behaviors (eg, start filling out forms; form line)- Set up & communicate ground rules – signage, announcements- Maintain visible presence of security and support staff – enforce "house rules" to

discourage harmful seed behaviors from growing into collective behaviors- Know when to call Security

WORKING WITH CROWDS

Zeitz et al 2009 Prehosp Dis Med 24:32-8

● Open doors to facility earlier than advertised to prevent crowd buildup

● If possible, use more than one entrance to avoid bottlenecks

● Keep crowd informed about what is going on inside the facility

● Attend to people’s basic needs and comfort while they are waiting eg, water, restroom facilities, seating, special needs

● Train all responders in PSB techniques for working with crowds

Crowd Management: Report of the Task Force on Crowd Control and Safety.Submitted to Sylvester Murray, City Manager, Cincinnati, Ohio, July 8, 1980

SPECIFIC PSB TECHNIQUES FOR WORKING WITH

CROWDS GATHERING FOR SERVICES

A young mother who is certain she and her baby were exposed to radiation shows up at the health department seeking medical advice. She will not keep her place in line at the registration desk, pushing ahead of others. She has been asked to wait with the others, but she begins wailing loudly and shouting that if she doesn’t get her baby treated quickly the baby will surely succumb to radiation exposure. It is clear that her agitation is becoming contagious; the crowd is becoming restless.

You are a public health staff person called to the scene to help: What can you do to address this situation?

VIGNETTE

PSYCHOLOGICALFIRST AID

(PFA)

PSYCHOLOGICAL FIRST AID (PFA)A form of mental health assistance provided in the immediate aftermath of disaster, to address acute distress and promote coping and functioning

Provided by mental health and other disaster response workers

Flexible for use in a variety of settings, populations, and cultures

Developed through expert consensus

(PFA is intuitive and is consistent with available scientific evidence, but research to demonstrate efficacy is needed)

Psychological First Aid Field Operations Guide, Natl Child Traumatic Stress Network & Natl Center for PTSD.North, Hong, Pfefferbaum 2009, Practical Front Line Assistance for Support and Healing, version 3 (P-FLASH III).

PSYCHOLOGICAL FIRST AID (PFA)10 elements of PFA:

1) Being there – physical support, engagement2) Safety and acute stabilization3) Supportive listening & information gathering4) Education & reassurance5) Coping & stress management6) Problem solving7) Connect with support8) Symptom management9) Know when more help is needed

10) Caring for the caregivers

Clothing – dry socks, warm shirt, blanket; food, water, coffee; kleenex; ambiance (warm/cool, dry, light/dark, clean, quiet); quiet comfortable place to sit/talk/be alone; restroom, shower; phone; medical needs, medications (don’t forget special medical needs)

1) BEING THEREBe unobtrusive, helpful, and compassionate Approach the setting first as a caring helper, not as a worker with a mental

health mission Be an anchor: your focused, calming presence will influence others

Address immediate physical needs, comfort, and concerns This is a powerful mental health function! Your presence in itself can be comforting ("ministry of presence") Ask: “Is there anything you need?” “Is there something I can do to help you

be more comfortable?” Your care for people’s needs is also a means to an end....preparatory

activity to intentional mental health work (helps connect you)

BEING THERE.... People needing your assistance may be:

- Those who seek out your help- Those who clearly need help and will tell you if you inquire- Those who do not obviously need help but will tell you if you inquire- Those who reject your help (later they may possibly be more receptive)

Respect interpersonal styles (sometimes cultural)- Touch – some people find it comforting, others find it invasive- Physical distance – too close is invasive (varies by individual)- Eye contact – in some cultures, prolonged eye contact is inappropriate- Privacy and trust – some people will be slow/hesitant to open up

Be sensitive to interpersonal cues about touch, distance, and privacy

2) SAFETY AND STABILIZATION

Protect people from further harm

Attention to physical safety is actually a mental health intervention:

If you can help keep people safe from physical harm they are less likely to suffer psychological trauma from that harm

Protect people from ongoing disaster-related and post-disaster hazards (such as contaminated areas, unsafe building structures, broken glass, and sharp objects)

SAFETY AND STABILIZATION…

Protect people

Protect people from other harm such as:- Exposure to traumatic images (eg, witnessing horrific

scenes in the disaster aftermath)- Reminders (eg, through extensive media viewing) - Loss of privacy (eg, to media personnel, onlookers,

attorneys)

Protect people from people: individual and crowd level redirection, stabilization, and de-escalation

3) SKILLED LISTENING

Listen to the stories with concerned interest- a mental health function

Invite thoughts - gently probe for detail- don't extract unnecessary painful trauma details

(follow the person’s lead; take cues from the person)

- don't force feelings; let them emerge spontaneously(and prepare for intense emotions)

Gather appropriate information: exposures, injuries, medical history, medications, psychiatric history

Varies by whether a psychiatric disorder is present or not:

If NO psychiatric disorder Normalize the experience:

Validate common emotional reactions Disturbing feelings don't equal mental illness

("Normal responses to abnormal events") Most people don't develop mental illness - symptoms subside with time

If psychiatric disorder is present Overcome stigma: Biological basis of persistent emotional changes and medication

mechanisms Many treatment options available: treatment is effective

4) EDUCATION & REASSURANCE

Lend permission to cry, feel bad, be nonproductive, focus on self for a period of time

Regain control of some aspect; restore routine

Utilize social supports

Positive self talk

Appropriate use of humor

Self care (easy to neglect in crisis)- sleep, meals, hygiene, exercise, habits, down time, relaxation,

pleasurable activities – achieve a healthy balance (avoid excesses)

Active coping is the healthiest

5) COPING & STRESS MANAGEMENT

Natural part of the healing process- Making meaning- Finding greater perspective in one's life

Discover and respect personal values - What is important to the individual- Avoid judgment; avoid "blaming the victim"

Personal roles: "victim," "survivor"- Listen to the person's language in self description

Philosophy, spirituality, world view

....FINDING MEANING & PERSPECTIVE

● Make a list; prioritize

● Weigh advantages and disadvantages of potential choices

● Develop more than one approach- allows a backup if Plan A doesn't work

● Try new behaviors and develop new skills

● One step at a time - manageable units first

● Keep sight of larger perspective and progress

6) PROBLEM SOLVING

● Two main sources of support can help people in times of disaster: Family and friends

- People who know the individual are best situated to comfort and support that person

Support services (eg, social workers, medical providers, FEMA, welfare services)

- Professionals have skills and resources that may help people get back on their feet

● Social supports and needed resources can go a long way toward helping people feel better

● People who lack social supports may be at increased risk for psychological adjustment problems

7) CONNECT WITH SUPPORT

8) ACUTE SYMPTOM MANAGEMENT

● In the early post-disaster period, the most bothersome post-traumatic symptoms are likely to be hyperarousal symptoms:

Feeling jittery, jumpy, restless, irritable Nervousness, anxiety, worry, fear, panic Insomnia

● Ways to manage these acute hyperarousal symptoms: Distraction – engage in absorbing or pleasurable activities (games,

puzzles, reading, movies, social events); selective focus Relaxation techniques – deep breathing, muscle relaxation, pre-hypnotic

induction Pharmacotherapy

To help people calm down or relax - good in office settings (originally used to help pregnant women to relax) or in crises

Ultimate goal is to use in critical or stressful conditions – but learn it in calm situations to develop mastery

Use comfortable chair, plant feet on floor, close eyes, take deep breath and hold as long as possible, then slowly exhale with suggestion: "the more slowly you let out the air the more relaxed you will feel."

Practice in sets (max. 5-6) with same instructions every time (max. 2-3 times a day). Compare heart rate before and after.

- For insomnia, jumpiness, hypervigilance, anger

RELAXATION: DEEP BREATHING

Lie supine on flat surface – get comfortable, close eyes

Tense one muscle group (eg, both eyes; one thigh) and hold for several seconds, then release and feel the muscles relax

One at a time, systematically tense and release all muscle groups of the body (eg, head toe)

On completion, bask in the sensation of relaxed muscles

Repeat as many times as desired


MUSCLE RELAXATION

Instruct individual to lie comfortably on floor, eyes closed. Read scenario in hypnotic, calm, quiet tone of voice.SCRIPT: "Imagine yourself on a beach, contemplating the clear blue water, waves slowly lapping up along the shoreline. It’s a perfect day—the air is warm and slightly breezy; the sun warms your skin. The salt air is refreshing and nostalgic. You walk to the edge of the water and scoop up some seashells. A gentle wave laps up over your hand and carries some of the smaller shells off into the ocean with it. The receding waves gently wash the sand from around your toes and you burrow them into the soft wetness again...." (and it goes on)

RELAXATION: PRE-HYPNOTIC INDUCTION


Indications that more help may be needed:

- Intolerable symptoms persist or escalate despite interventions- Pre-existing psychiatric/substance use disorder requiring ongoing care- The person requests additional assistance- The person worries you

Indications that urgent help may be needed:

- The individual is too overwhelmed to be able to care for self and/or dependents (eg, stops eating/drinking; neglects child)

- Indications of impending harm to self (suicidality) or others (homicidality/assaultiveness/extreme agitation)

- The person cannot be oriented (eg, delirious)

9) KNOW WHEN MORE HELP IS NEEDED

10) CARING FOR THE CAREGIVERS

Disaster workers may themselves experience psychological distress or even become mental health casualties in difficult circumstances of disaster settings:

Extended exposure to intense emotional distress

Personal exposure to injury and contamination

Personal exposure of self and loved ones to the disaster; worry about safety of loved ones and personal property

Difficult working conditions, chaos

Long work hours, cumulative fatigue

Separation from usual supports and familiar comforts

Ethical dilemmas

...THE CAREGIVERS....Stressors experienced by disaster workers:

Exhaustion, inefficiency, loss of enthusiasm or interest for the work

Diminished ability to focus and concentrate

Preoccupation, inability to put thoughts and images aside, dreams of the post-disaster setting and people

Guilt feelings, worry, despondency, irritability, anger

Frustration (over inability to do enough; with response of leadership and authorities; with circumstances)

Burnout, "compassion fatigue"

Interpersonal conflict and damage to relationships

ADVICE FOR CAREGIVER SELF-CARE

First, follow the same basic advice recommended for those you are caring for (rest, nutrition, hygiene, exercise, relaxation, healthy balance)

Care for your colleagues- Give them a break- Offer positive support and encouraging words- Keep an eye on their fatigue level and help them accept needed rest,

nutrition, and time off

Spend restorative time together (eg, breaking bread together; follow-up meetings to review the operation and work out the kinks for next time)

Supervisors can help disaster personnel by: distributing work loads equitably

monitoring workers for signs of distress and fatigue

communicating with workers to keep them informed and learn about problems/needs that arise

providing encouragement

facilitating opportunities for peer support

providing psychological support through formal group or individual therapy

ADVICE FOR CARING FOR THE CAREGIVERS

A teenage girl is brought to the emergency department for evaluation. As soon as the nurse calls her to the exam room, she begins to panic and hyperventilate. She asks, "Am I going to die?"

How can the nurse help this girl?

VIGNETTE: PFA

RISKCOMMUNICATION

…in a terrorist incident involving

radioactive materials, effective

risk communication may be the

most important way to reduce

morbidity and mortality…

Becker 2007 BMJ 335:1106-7, p. 1107

Risk communication is your job…...it is the business of all responders

A process of providing information for the purposes of reducing anxiety/fear and promoting appropriate responses to a major crisis

Communication with populations through media and in person with groups and individuals

RISK COMMUNICATION

Purpose:

Provide guidance to help people respond appropriately and safely

Offer appropriate reassurance

Inform people of what is being done for them and what are the plans

People feel better and act more safely when:

they feel they know what is going on they have confidence in the reliability of the information provided

Covello et al 2001 J Urb Health/Bull NY Acad Med 78:382-91

RISK COMMUNICATION

Some key concepts and facts are so basic to RAD/NUC incident response that all responders should know them

Knowing this information can help responders stay safe in the RAD/NUC response environment

Communicating this information can reassure people and help them respond appropriately and safely to their situation

KEY CONCEPTS & FACTS FOR RAD/NUC

EXPOSURE VS. CONTAMINATION

● Exposure occurs when energy traveling in waves or particles (radiation) penetrates the body (irradiation)

● Contamination occurs when radioactive material in the form of dust, powder, or liquid comes into contact with the body, and the radioactive source continues to emit radiation

- External: radioactive material on a person's exterior (skin/hair/clothes)

- Internal: radioactive material entered the body through open wounds, absorption through skin, mucous membranes, swallowing, or breathing

IMPLICATIONS OF EXPOSURE VS. CONTAMINATION

● People who have been exposed/irradiated (without contamination) are not radioactive

For example, having an X-ray taken, which exposes you to radiation, does not make you radioactive

● Contaminated people have loose particles of radioactive material (dust/dirt) that emit radiation and may be spread to contaminate others and the environmentDecontamination should be done as soon as possibleContamination is easily removed by changing clothes and

showering (use simple soaps and don't abrade skin)

Addressing contamination issues should not delay treatment of life-threatening injuries

● Externally exposed patients do not become radioactive- Not a radiation risk to medical responders

● Levels of radioactivity emitted by patients with external or internal contamination are unlikely to cause medical harm to care providers- Decontaminate external contamination as soon as possible

without delaying critical care (use respiratory precautions)

RESPONDERS: DON'T FREAK OUT

Centers for Disease Control and Prevention 2005. Radiological Terrorism: Emergency Management Pocket Guide for Clinicians. http://www.bt.cdc.gov/radiation/pdf/clinicianpocketguide.pdf

● TIME: The more time you spend near the radiation source, the greater your exposure will be

● DISTANCE: The closer you are the source, the greater your exposure will be- Radiation exposure decreases with distance according to the inverse-

square law: if you triple your distance from a radiation source, your exposure decreases by a factor of 9 (ie, 32)

● SHIELDING: The greater the shielding between you and a radiation source, the less you will be exposed- Lead and concrete are best, but staying behind vehicles, buildings, or other

objects can also decrease exposure

3 FACTORS DETERMINE EXPOSURE

US Environmental Protection Agency 2010. Radiation Protection Basics. http://www.epa.gov/rpdweb00/understand/protection_basics.html

FRIENDLY FACTS FOR NUKES

● Immediately after a nuclear detonation, the safest action is to seek shelter for 24 hours in a location deepest within the biggest building that has the thickest brick, stone, or concrete walls (wood and thin metal are not as good), or underground- Eg, optimal location within a large solid building can reduce exposure by a

factor of 50 (being in a vehicle provides little fallout protection)

- This is why immediate sheltering in place can be far safer than evacuation

● A "dirty bomb" is not a nuclear bomb and causes far less destruction and injury- The greatest harm is likely to be from the explosion itself

Homeland Security Council 2009. Planning Guidance for Response to a Nuclear Detonation. http://bit.ly/aeVGl2

Acute risk communication needs in RAD/NUC incidents

1. Immediate population safety Eg, after nuclear event: shelter in place – "Get inside NOW!"

2. Surge prevention Providers of medical care and information become overwhelmed

- Cesium-137 incident killed 4 in Goiânia, Brazil in 1987: 112,000 people sought radiological monitoring in special facilities

Highways become clogged after nuclear event- Three Mile Island: for every person asked to evacuate, 45 did (150,000 in all)

Collins & Carvalho 1993 Behav Med 18:149-57;International Atomic Energy Agency 1988. The radiological accident in Goiania, STI/PUB/815. Vienna:

IAEA;Erickson 1994, A New Species of Trouble: The Human Experience of Modern Disasters, New York: Norton

RISK COMMUNICATION FOR RAD/NUC

A two-way communication process Start by soliciting and listening to people’s specific concerns Respond with timely & regular updates

Concerns to expect based on experience and research Personal safety● How to keep my self / family / pets safe?● Where should I go to be safe? How can I avoid exposure?

Health● How do I know if I have been exposed?● What symptoms should I look for?● How (and when) can I get tested?● What will they do if I have been exposed?● What effects will I have short / long term if I have been exposed?

RISK COMMUNICATION: GETTING STARTED

Having a repertoire of audience-tested, scientifically grounded prepared messages available means that vital information can be released almost immediately

Becker 2004 Biosecurity & Bioterrorism 3:195-207

Types of messages to have ready for RAD/NUC incidents

● Seek safety (eg, shelter in place)● Stay put: shelter in place until radiation subsides● Determining one's exposure● Health measures to take (eg, decontamination)

HAVE MESSAGES READY

● Have an objective – eg, stir people to action; wait for instructions● Target the intended audience – eg, uneducated groups, children,

parents of small children● Develop an approach – get people's attention and motivate them to

take the appropriate action● Organize your message – prepare in advance

Have your facts in order Be concise/brief Short sound bites (but not to the extent of losing the information) No more than 2-3 major take-home messages ("talking points")

DEVELOPING YOUR MESSAGE

A fallout cloud from a nuclear detonation is moving toward your city and is expected to cover a wide area of the city, beginning within the next hour. You need to craft a message to provide immediate safety information to save the lives of people in the affected area.

EXERCISE: MESSAGE PREPARATION

Now construct your message – Consider:● What is your risk communication objective?● Who is your intended audience?● How do you capture their attention and motivate them to

take appropriate action?● What facts do you need to support your arguments?

● Speak in terms of "we" Builds unity/sense of strength ("I" and "you" can be isolative and divisive)

● Avoid humor May be perceived as offensive, not taking situation seriously, and lacking

compassion

● Avoid jargon/define terms Shelter in place, plume, "dirty bomb"

● Avoid being sidetracked by questions that lead you away from your message Eg, if you are asked a question that requires speculation or derails the

discussion to an unhelpful topic, don't go there and instead segue to the message you want to get out


TIPS FOR DELIVERING YOUR MESSAGE

Find the right person to deliver the message The spokesperson's credibility is as important as the credibility of

the message Partner with known credible sources

Model calmness, confidence, and compassion Be honest and forthcoming Do not mislead people (eg, by withholding information needed to

understand the issues) Admit not knowing – rather than guessing Avoid "no comment" – sounds suspicious, like a cover-up


ESTABLISHING TRUST AND CREDIBILITYIN RISK COMMUNICATION

When available information is ambiguous or insufficient: Don't speculate or forecast what you don't know as fact

Stay with the current situation Avoiding making ultimate projections or guarantees

- Promise only what you can deliver Focus on what is known:

Identify known safe zones Provide practical measures people can take Say when & how more will be known / communicated

Norwood et al 2001 Milit Med 166 S2:27-81;Covello et al 2001 J Urb Health/Bull NY Acad Med 78:382-91

RISK COMMUNICATION:MANAGING AMBIGUITY

Anticipate anger, hostility, and blaming Avoid blaming and criticizing others during the heat of the crisis Do not repeat accusations/allegations when responding to questions Attack problems, not people or organizations

Listen to people’s concerns and frustrations Seek to understand the source of the anger and hostility

(eg, fear/anxiety, frustration, hurt/loss) Indicate you have heard the person – reflect back Validate the person’s feelings

Communicating empathy, caring, and compassion may help de-escalate anger and hostility Respond to emotion with understanding – not just providing facts Target your responses to concerns expressed

RESPONDING TO ANGER AND HOSTILITY

A dirty bomb was detonated in the southwest quadrant of the city. Weeks later, even though the area has been completely cleaned up, people are avoiding stores, restaurants, and schools in the area because they fear they will be contaminated with radiation. If this pattern continues, it will cause severe economic crisis in the area.

How can the city council work to resolve this problem?

VIGNETTE: RISK COMMUNICATION

CONFLICTRESOLUTION

GUIDELINES FOR CONFLICT RESOLUTION First priority: good relationships Stay calm, be patient, respect others' opinions, be courteous, remain constructive

under pressure, be flexible

Listen first, talk second Use active listening skills to ensure you hear others’ positions and perceptions Listen with empathy – appreciate the conflict from the other person’s viewpoint Restate, paraphrase, summarize, clarify feelings Use "I" statements

Separate people from problems Debate real issues without damaging working relationships Do not assume that the other person is just "being difficult" – real and valid

differences can underlie conflictive positions Avoid attacks on personality – focus on achieving the mission

Lee et al, World J Surg 32:2331-5, 2008; Levine 1998, Getting to Resolution:Turning Conflict into Collaboration, Berrett-Koehler Publishers, San Francisco

Agree on problems to be solved and set mutual goals Openly seek the other party's cooperation to solve the problem The conflict is likely to be a mutual problem, but people may have

different perceptions of the problem Objectify effects of the conflict on the operation's performance, team

work, and decision-making Identify areas of agreement and areas of disagreement

Clarify interests on each side Identify the other person's interests, needs, concerns, perceptions, and

motivations underlying the position adopted Understand the other person's position before attempting to defend yours Try to appreciate the effects of your actions on the other person's position

CONFLICT RESOLUTIONSTEP 1: DEFINE THE PROBLEM


Brainstorm solutions together Allow all interested parties to give input Together consider many options Be open to all ideas, including ones you never considered before Because problems may have multiple solutions, creativity helps

Respect individual differences but encourage flexibility Accept that people can have different approaches and motivations Earnestly consider various options to help people avoid becoming too

entrenched in a fixed position

Seek to keep discussions positive & constructive Helps circumvent antagonism and dislike that can escalate conflict

CONFLICT RESOLUTIONSTEP 2: BRAINSTORM POSSIBLE SOLUTIONS


Try to resolve real differences identified between parties Avoid getting stuck on positions, which can lead to entrenchment of ego

to blindly defend perceived personal threat and "save face" Focus instead on shared interests and basic guidelines toward achieving

mutual goals

Resolution can begin once both sides understand one another By now, a mutually satisfactory solution may be apparent to all parties If not, seek a solution that satisfies everyone (or is at least tolerable to

everyone) to achieve a "win-win" solution

Operationalize steps to be taken once an acceptable solution is found

CONFLICT RESOLUTIONSTEP 3: NEGOTIATE A SOLUTION


psb t echniques & p rocedures for r ad /n uc d isaster r esponse

Documents