Second Victim Syndrome

Second Victim Syndrome (SVS)


  • Medical errors are the third leading cause of death in the US

  • Poor outcomes can be due to a larger system failure or a human error

    • Examples include incorrect medication dosages, improper management, harm during a procedure, missed diagnoses, etc.

  • Second victim

    • Defined in 2000 by Albert Wu

    • In situations where medical errors are made or safety is compromised, the first victim is the patient and the second victim is the healthcare professional (EMT, nurse, physician) who can also be affected or traumatized by the event.


  • Aforementioned events can have a lasting impression on a provider

  • He/she tends to repeat the event over and over in his/her mind leading to emotional distress and scars

  • Immediate symptoms

    • Anxiety, guilt, shame, sadness, fear, anger

    • Can have sympathomimetic manifestations—tachycardic, elevated BP, etc

  • Later symptoms

    • Depression, loss of confidence, loss of job satisfaction, hypervigilance, poor decision making

  • Can develop PTSD like symptoms

    • Insomnia, flashbacks, SI, isolation

Identifying Second Victims

  • Symptoms and behavior can be similar to those who suffer from burn out

  • Different stages of SVS (see below)



  • Support from colleagues is helpful

    • Provides a sense of shared understanding

  • M&Ms/patient safety conferences that are supportive instead of punitive

  • Culture change

    • Shift toward a “Just Culture”

      1. Balancing accountability and support instead of perpetuating a blame/shame culture

  • TRUST mnemonic

    • Treatment that is Just

    • Respect

    • Understanding and compassion

    • Supportive care

    • Transparency and opportunity to contribute