Patient safety has become a challenge and a priority of all health systems. Despite this, many patients still suffer different damage arising from health care


When there is serious injury to the patient, patients and their families must be supported by the Organization and receive the appropriate information. But professionals and institutions can also suffer as a result of these adverse events.

The term «second victim» was introduced by Wu [ii] in 2000 to refer to the professional who is involved in an adverse event and remains traumatized by that experience, or is not able to deal emotionally with the situation.

The most common emotional reactions of the second victims are: anxiety, confusion, obtundation, lack of concentration, depersonalization, frustration, feelings of guilt, sadness, mood swings, insomnia, re-experimentation of the event, doubts about the own professional ability, fear the legal consequences and the loss of reputation. All this can lead to personal and professional medium-long term consequences as the consumption of harmful substances, changes in the attitude towards work, abandonment of the profession or even conduct suicide.

Different initiatives that promote both processing information of patients and relatives adverse as the second victims and institutions through the development of crisis plans has recently been developed in our country.

The consensus conference “Information about patients and relatives adverse events’ [iii], promoted by the health Area of ISDE recommends policies and institutional guidelines favoring the process of adverse patient events information. The need for professional training in skills of communication as well as the development of strategies of support professionals who are involved in an adverse event are stressed.

The Safety strategy of the patient of the National Health System 2015-2020 [iv] includes strategic lines providing patients who have suffered an adverse event serious in time, clearly, sincere and timely information about what has happened, and offer support to professionals involved in a serious adverse event.

The Spanish system of Safety Notification in Anaesthesia and Resuscitation (SENSAR) has published “The Response to an Adverse Event Guideline” [v]. The Guide encourages open, honest communication and empathetic with the patient and family; it provides tools to give emotional, professional, and legal support to the team of professionals involved in an adverse event, promoting processes that ensure that the system has been revised to prevent similar risks in the future.

The Research Group of Second and Third Victims has produced a guide’s recommendations (only available in Spanish) to offer an adequate response to the patient after an adverse event and attend to the second and third victims. It includes an intervention program for professionals [vi]. 

All these initiatives should promote and encourage that the health system could be able to provide not only necessary to support patients and their families, but also to professionals and institutions that are involved in an adverse event while we continue working to offer a safer health care.

Dra. Mari Cruz Martín.
Head of Intensive Care Medicine.
Hospital Universitario de Torrejón.
Vicepresident of SEMICYUC.


[i] James JT. A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care: J Patient Saf. 2013;9(3):122-8.

[ii] Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000; 320(7237): 726-727.

[iii] Martín-Delgado MC, Fernández-Maillo M, Bañeres-Amella J, Campillo-Artero C, Cabré-Pericas L, Anglés-Coll R, Gutiérrez-Fernández R, Aranaz-Andrés JM, Pardo-Hernández A, Wu A.[Consensus conference on providing information of adverse events to patients and relatives].Rev Calid Asist. 2013 Nov-Dec;28(6):381-9

[iv] Ministerio de Sanidad, Servicios Sociales e Igualdad. 
Safety strategy of the patient of the National Health System 2015-2020 . Periodo 2015-2020.