In the event of an adverse event associated with care, attention is rightly focused on the patient. However, the healthcare professional involved may also be deeply affected. This is referred to as the caregiver being the "secondary victim."

This situation corresponds to emotional distress that may involve guilt, anxiety, loss of confidence, fear of how others perceive them, or medical-legal concerns. This reaction is common, normal, and well documented. When it is not recognized or addressed, it can affect the professional's health and clinical practice and have a direct impact on patient safety.

Identifying a secondary victim situation in a caregiver

Support must be offered as soon as a serious adverse event occurs or when a professional shows unusual signs, such as:

• withdrawal or isolation,
• excessive guilt or rumination,
• persistent anxiety,
• significant medical-legal concern,
• change in usual professional behavior.

The role of healthcare managers and colleagues isto identify these signs early on and provide support. It is not a question of analyzing the event, evaluating practices, or assigning blame.

What message should be sent to a caregiver who is a secondary victim?

The initial contact should be simple, clear, and nonjudgmental. The key message is as follows:

"What you're feeling is common after this type of event. You don't have to deal with this alone."

This message helps to acknowledge the emotional impact, normalize the reaction, and facilitate access to help, without getting into a technical or organizational analysis.

Supporting a second victim: the role of the healthcare manager

Healthcare managers play a central role in supporting secondary victims. Where possible, the institution's internal resources should be mobilized as a priority:

• school psychologist or support unit,
• occupational medicine,
• house of psychology,
• quality officer, risk management officer, or second victim officer.

The challenge is not only to inform, but to make seeking support legitimate, accessible, and non-stigmatizing. The framework facilitates connections in practical terms and makes the process secure.

External resources for caregivers in difficulty

If the professional does not wish to or cannot mobilize internal resources, it is essential to provide them with reliable external solutions that can be contacted immediately.

• SPS Association – Care for Healthcare Professionals
  National number: 0805 23 23 36
  Available 24/7 with trained professionals.
• National Council of the Order of Physicians (CNOM)
  Helpline: 0800 288 038
  Support and guidance service for physicians in difficulty.

In the event of medical-legal concerns, reminding patients of the existence of professional insurance or legal protection also helps to reduce anxiety and restore a sense of security.

Second victim: attitudes to avoid

Certain reactions can aggravate the professional's suffering and should be avoided:

• minimize how he feels,
• analyze the event as it unfolds,
• look for someone responsible,
• promise no consequences,
• require an immediate return to a risky activity while the emotional impact persists.

When should care for a secondary victim caregiver be reinforced?

If the professional shows signs of severe distress, major disorganization, dark thoughts, or a risk to themselves or patients, the manager must act immediately:

• activation of occupational medicine,
• referral to specialized psychological support,
• temporary suspension of clinical activity if necessary.

Second victims and patient safety: an inseparable issue

Supporting a second victim is neither incidental nor optional. It is an essential action to:

• patient safety,
• prevention of psychosocial risks,
• development of a just and learning culture in healthcare institutions.

Supporting professionals after an adverse event directly contributes to the quality, reliability, and safety of care.

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