Second victim

Background

• Second victims are healthcare providers in the midst of a medical mistake or error and become victimized because of their role.

• University of Missouri Health canter found almost 1in 7 staff reported experiencing a patient safety event resulting in personal disturbed emotions.

Clinical Features

• Immediate.
  • Stress related psychological and physical reactions:
    • Sadness, Fear, shame and anger
    • Panicking, horrified and apprehensive.
    • Sympathomimetic reaction with tachypnea, tachycardia, elevated blood pressure and difficulty concentrating.
    • Lonliness and fear of being called names and losing job.
• Subsequent.
  • Fear of returning to work.
    • Loss of confidence.
    • Self doubt, remorse.
    • Hypervigilence, second guessing everything.
• Ongoing till resolved.
  • Characteristics of PTSD (inability to process the feeling of fear, sadness, guilt and shame).
  • Resulting in:
    • Insomnia, flashbacks and thoughts of suicide.
    • Damaged self perception.
    • Loss of self security.

Differential Diagnosis

• Anxiety neurosis.
• Thyrotoxicosis.
• PTSD.
• Depression.

Evaluation

• The second victim should be treated on urgent basis.
• Second victim code should be announced and a separate team should provide help to the person, besides the team evaluating the incidence.