Second Victim

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  • 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 1 in 7 staff reported experiencing a patient safety event resulting in personal disturbed emotions.[1]

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.


  • 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.


  • Five rights of the second victim.[2]
    • Treatment that is just.
    • Respect.
    • Understanding and compassion.
    • Suppostive care.
    • Transparency and opprtunity to contribute.
  • Recovery process of the second victim.[3]
  1. Chaos and accident response.
  2. Intrusive reflections.
  3. Restoring personal integrety.
  4. Enduring the inquisition.
  5. Obtaining emotional first aid.
  6. Moving on. Which can lead to either of the three.
    1. Dropping out.
    2. Surviving.
    3. Thriving.

See Also

External Links


  1. Scott SD. The "second victim" phenomenon: a harsh reality of health care professions. AHRQ; WebM&M Perspectives on Safety; May 2011.
  2. Denham CR.TRUST: the 5 rights of the second victim. J Patient Saf. 2007; 3: 107-119
  3. Scott SD, Hirschinger LE, Cox KR, et al. The natural history of recovery for the health care provider "second victim" after adverse patient events. Qual Saf Health Care 2009;18:325-30.