RESCUE Certification Standards for Second Victims Support Interventions (RESCUE-Intervention)

Scope. RESCUE-Supporters encompasses the design, orientation, structure, methodologies, training, implementation, procedures, evaluation, and continuous improvement of support interventions implemented in healthcare and social-healthcare institutions to provide assistance to second victims aligning with ERNST's definition of second victims . This certification provides institutions with a structured framework to ensure the quality of their second victim support initiatives through evidence-based interventions and robust organizational practices benefiting patients, professionals, and the institution itself in achieving its goals.

Vanhaecht K, Seys D, Russotto S, Strametz R, Mira J, Sigurgeirsdóttir S, Wu AW, Põlluste K, Popovici DG, Sfetcu R, Kurt S, Panella M; European Researchers’ Network Working on Second Victims (ERNST). An Evidence and Consensus-Based Definition of Second Victim: A Strategic Topic in Healthcare Quality, Patient Safety, Person-Centeredness and Human Resource Management. Int J Environ Res Public Health. 2022;19(24):16869. doi: 10.3390/ijerph192416869.

By setting clear criteria and benchmarks, RESCUE-Intervention enables institutions to guarantee the adequacy of support programs. This framework fosters recovery and resilience while promoting safer and more supportive environments for healthcare professionals. When using this certification guide, the specific setting (hospitals, primary care facilities, or social-healthcare centres) must be selected, as the criteria may vary depending on the context.

This certification is applicable to institutions that have designed their intervention (design level), those with firmly implemented in place support interventions (execution level), those that have completed at least one three-year cycle of evaluation and improvement as certified at the execution level (comprehensive level).

This certification is complemented by the accreditation of the peer supporters training program (RESCUE-Training). When an institution holds accreditation for its peer supporters training program (RESCUE-Training) and achieves the Comprehensive level in the RESCUE-Intervention, it qualifies for the RESCUE Mastery Certification in its approach and leadership to and support for second victims, as part of its patient safety strategy.

Below is a brief introduction to the RESCUE-Intervention Certification Standards. This framework is divided into two main sections:

RESCUE – Intervention, Design level, which define the support intervention program requirements. When the institution is planning to implement a support program.
- Elementary criteria (RIDE01 to RIDE17): Covers basic standards for designing the support program, including institutional policies, codes of conduct, interdisciplinary coordination, referral protocols, and provision of adequate spaces for interventions.
- Advanced criteria (RIDA01 to RIDA11): Details advanced standards such as promoting Just Culture, proactive and reactive approaches, specific support for residents and students, and the inclusion of patient representatives in the leadership team.
RESCUE – Intervention, Execution level, detailing how the program has been implemented, with at least one year of experience:
- Elementary criteria (RIE01 to RIE25): Focuses on the practical implementation of the program, covering strategies to reduce clinical errors, resource availability, mentor training, victim follow-ups, and minimizing psychological and occupational impacts.
- Advanced criteria (RIEA01 to RIEA12): Advanced standards ensure continuous monitoring of implementation, such as evaluating the impact of group and individual interventions and providing extended support outside the workplace.
RESCUE – Intervention, Comprehensive level, detailing the how the improvement cycle methodology is applied while monitoring the adequacy, effectiveness, and acceptability of approaches and outcomes:
- Elementary criteria (RICE01 to RICE12): Focused on integrating the continuous improvement cycle, with periodic reviews of policies, referral protocols, transparency in incident management, and overall program impact evaluations.
- Advanced criteria (RICA01 to RICA06): Includes standards for evaluating interventions, preventing emotional exhaustion, monitoring specific groups such as students and residents, and measuring the legal claims’ impact on the program.

Overall, these standards ensure that the intervention is aligned with the advancements and developments consolidated by leaders in the sector, ensuring their recovery and promoting their resilience to face future highly stressful events.

These standards are the result of a collaborative effort by an international team that is part of the Innovative Grant funded by COST 19113 (https://cost-rescue.eu). These standards are designed to align with the principles on the second victim phenomenon established by ERNST .

Mira J, Carillo I, Tella S, Vanhaecht K, Panella M, Seys D, Ungureanu MI, Sousa P, Buttigieg SC, Vella-Bonanno P, Popovici G, Srulovici E, Guerra-Paiva S, Knezevic B, Lorenzo S, Lachman P, Ushiro S, Scott SD, Wu A, Strametz R. The European Researchers' Network Working on Second Victim (ERNST) Policy Statement on the Second Victim Phenomenon for Increasing Patient Safety. Public Health Rev. 2024 Sep 18;45:1607175. doi: 10.3389/phrs.2024.1607175.

The validity of this certification is five years. Before this period expires, institutions wishing to maintain the RESCUE certification must apply for renewal.

Procedure

The auditor will take into account the centre’s self-assessment results and verify the supporting documentation provided, then proceed with their evaluation. The entire process is conducted on the RESCUE platform. The self-assessment and audit cover actions that were designed or implemented within the past three years.

There are two levels of certification. The first, Elementary Certification, corresponds to standards classified as elementary. The second, Advanced Certification, includes additional standards classified as advanced. In this second category, the criteria for Elementary Certification must be met, along with the additional criteria for compliance with the advanced standards.

The auditor will use the following scale to determine the degree of compliance with the standard in both cases.

Full Compliance (FC). The standard is fully met.
- Example: The commitment to the support program's Code of Conduct is signed by all peer supporters and the institution's leadership, when all of them have signed the Code of Conduct and this can be verified.
Partial Compliance (PC). The standard is partially met, but some elements are incomplete or missing.
This does not apply to CORE standards, which only allow for FC.

Partial compliance refers to cases where the unmet or incomplete elements are minor and do not compromise the overall purpose or objectives of the standard. None of the unmet elements are considered critical for the respective category (Elementary or Advanced Certification), and the total incomplete components must not exceed 25% of the required elements. Furthermore, these elements must not prevent full compliance from being achieved within six months. In cases where a compliance rate of 60% or 80% is specified, the appropriate proportion will be determined in alignment with this guideline to ensure consistency with the stated requirement.

The support application's algorithm facilitates the correct implementation of this instruction.
- Example: The commitment to the support program's Code of Conduct is signed by all peer supporters and the institution's leadership, when 75% of them have signed the Code of Conduct and this can be verified.
Non-Compliance (NC). The standard is not met.
- Example: The commitment to the support program's Code of Conduct is signed by all peer supporters and the institution's leadership, when only 55% of them have signed the Code of Conduct and this can be verified.
Certification is granted if all CORE standards are met, at least 60% of the standards in each of the two sections are fulfilled, and partial compliance is achieved for 40% of the remaining standards. Failure to comply with a CORE standard means that the intervention cannot be certified at this time.

Setting: hospital

Level: Design

RESCUE- Second Victims Support Intervention Standards

Elementary criteria

N	Name	Standard	Source
RIDE01 (CORE)	Systematic actions to prevent recurrence of clinical errors or system failures	The analysis of severe safety incidents, utilizing appropriate techniques such as the London Protocol or other root cause analysis methods, is an integral component of the patient safety policy and is executed appropriately.	Institutional report of the reporting system.
RIDE02 (CORE)	Institutional policy to support second victims	An institutional policy exists to support second victims. Just Culture and no blame principles are emphasized. Support for second victims shall be integrated into institutional policies and clearly define responsibilities and resources. Stakeholders to be considered in this policy may include clinical commissions, council of chiefs’ of departments; Patient Safety or Occupational Health units, legal departments, and Mental Health units/psychologists for specialized support.	Institutional policy document on second victims’ support.
RIDE03	Second Victims Strategy as part of the centre's strategic planning	The Second Victims Strategy is a part of the Strategy and Action Plan for development of the centre.	Institutional policy document.
RIDE04	Intervention programme code of behaviour	The institution has designed codes of conduct that govern the policy of the intervention program	Code of conduct document which is approved by the institution.
RIDE05	Interdepartmental coordination for the provision of comprehensive support to second victims is in place	Coordination mechanisms between relevant structures and stakeholders involved in the second victim support intervention such as patient safety, quality of care, occupational health and safety, mental health, and legal services are clearly defined and documented in an action protocol or algorithm.	Protocols and algorithms of action of the structures and stakeholders involved in the second victim support intervention.
RIDE06	Multi-disciplinary structure of the second victim support intervention lead team	A multi-disciplinary structure of the second victim support intervention lead team is in place.	Institutional protocol document.
RIDE07	Institutional training protocol for peer supporters	A validated and institutionally approved training protocol for peer supporters is established in the institution.	Institutional peer supporter training protocol document.
RIDE08	Confidentiality of the service	The second victim support intervention has specific mechanisms to guarantee the confidentiality of the service.	Mechanisms for anonymisation or pseudo-anonymisation of data and records. Institutional peer supporter training protocol document.
RIDE09 (CORE)	Ensure support availability	The intervention has the necessary resources to provide support to second victims regardless of the date and time of the support request (24 hours a day, 7 days a week availability).	Institutional peer supporter protocol document.
RIDE10	Referral protocol for second victims	The support intervention has a referral protocol with logic trees and algorithms that facilitate peer supporters' decision-making regarding the type of support the second victim requires at any given time based on identifying key signs and symptoms that suggest the need for referral to higher or specialised levels of support.	Referral procedure included in the Institutional peer supporter protocol document
RIDE11	Accompanying the second victim back to work after sick leave or absence	A reintegration plan is considered for each second victim, tailored to their specific needs and concerns.	Institutional peer supporter protocol document.
RIDE12	Involvement of the second victim in the search for solutions	The possibility of involving the second victim in identifying solutions to prevent the recurrence of unsafe events is considered, as it helps address their psychological needs and contributes to improving overall healthcare outcomes.	Institutional peer supporter protocol document.
RIDE13 (CORE)	Suicide risk code in the second victim	The support intervention has a protocol or suicide code that triggers the use of procedure/algorithm for assessing the risk of suicide in the second victim and action to be taken if the risk is detected.	Procedure for suicide risk is included into the institutional peer supporter protocol document.
RIDE14 (CORE)	Transparency of patient safety incident management	The second victim support intervention has specific mechanisms to ensure the first victims' needs and rights are respected. This involves coordinating support for second victims with other institutional structures involved in the comprehensive management of patient safety incidents.	Protocol of serious adverse events. Check-list
RIDE15 (CORE)	Peer supporters receiving support	The support intervention should include mechanisms that allow peer supporters who are emotionally affected after an encounter with the second victim to receive support and accompaniment from a colleague who is also a member of the rapid response team.	Institutional peer supporter protocol document.
RIDE16	Appropriate spaces for debriefings	At least, a room designed to comfortably accommodate at least 8 people, equipped with proper acoustics, such as projector, or whiteboard, and additional amenities to facilitate effective group work	A dedicated space for this purpose.
RIDE17	Collaboration agreements with Universities and health professional training institutions to include aspects related to the phenomenon of second victims in the training curriculum of students	The health institution has established collaboration agreements with the University and health professional training centres for training in the phenomenon of second victims.	Institutional peer supporter protocol document.

When multiple data sources are indicated, any one of them is considered valid.

Advanced criteria

N	Name	Standard	Source
RIDA01	Safety culture based on Just Culture principles	An institutional policy exists to support Just Culture principles.	Just culture policy or protocol.
RIDA02	Institutional investment in prevention and self-care (levels 1 and 2 of second victim support)	A comprehensive (proactive and reactive) approach to the second victim phenomenon within the institution has been designed. This includes activities oriented towards preventing patient safety incidents and second victim response (level 1) and promoting individual and healthcare team self-care (level 2).	Institutional peer supporter protocol document.
RIDA03	List of recommended and forbidden phrases for second victim support (identification of red and green flags)	Identification of appropriate (green flag) and inappropriate (red flag) phrases for supporting second victims effectively	Institutional peer supporter protocol document.
RIDA04	Offering support to identified second victims through incident reporting systems	Support intervention should be offered to all second victims identified through incident reporting systems	Institutional peer supporter protocol document.
RIDA05	Support modalities available for second victims (one-to-one and group support).	Protocols, resources and mechanisms are in place to provide individual and group support to second victims.	Institutional peer supporter protocol document.
RIDA06	Specific support protocol for residents as second victims	There is a support protocol adapted to the particularities of the second victim phenomenon in residents (staff of the institution who are still in training).	Protocol for the care of the resident as a second victim.
RIDA07	Specific support protocol for student trainees/interns as second victims	There is a support protocol adapted to the particularities of the second victim phenomenon in students doing internships in social and healthcare institutions.	Protocol for the care of the student/intern as a second victim.
RIDA08	Offering support outside of work (e.g. always in case of sick leave)	Peer supporters and program coordinators should be available to provide guidance and assistance outside the workplace.	Institutional peer supporter protocol document.
RIDA09	Option to request a change of peer supporter	A mechanism has been defined whereby second victims accessing the support intervention can request to change their assigned peer supporter.	Institutional peer supporter protocol document.
RIDA10	Involvement of the second victim's family in the support process	Protocol is in place to ensure family involvement is sensitive, constructive, and respects the privacy and autonomy of the second victim	Institutional peer supporter protocol document.
RIDA11	Integration of a patient representative in the lead team for the second victim support intervention	A patient representative is appointed as an active and equal member of the board, contributing to discussions, decisions, and evaluations related to the program	Institutional peer supporter protocol document.

When multiple data sources are indicated, any one of them is considered valid.

Setting: hospital

Level: Execution

RESCUE- Support Intervention Standards

Elementary criteria

N	Name	Standard	Source
RIE01 (CORE)	A defined strategy to support second victims is in place and implemented.	An institutional policy exists to support second victims. It is a part of the Patient Safety Strategy. An action protocol to support second victims has been implemented for at least one year.	Institutional report of the reporting system. Approval date and program follow-up records.
RIE02	Systematic actions to prevent recurrence of clinical errors or system failures	In 70% of situations where a professional is identified as a second victim, a detailed analysis is carried out and an improvement plan is generated.	Incident reporting systems. Internal and external reports on incidents. Assessments and audits: Assessments of the effectiveness of corrective actions and audits of risk management processes .
RIE03	Intervention programme code of behaviour	The commitment to the support program's Code of Conduct is signed by all peer supporters and the institution's leadership.	Code of conduct documents signed by all peer supporters and institutional leadership.
RIE04	Interdepartmental coordination for the provision of comprehensive support to second victims is in place	The coordination mechanisms between relevant structures and stakeholders involved in the second victim support intervention—such as patient safety, quality of care, occupational health and safety, mental health, and legal services—are actively implemented and systematically executed. These mechanisms operate in accordance with a clearly defined and documented action protocol or algorithm, ensuring seamless collaboration and effective support delivery.	Records of interdepartmental meetings.
RIE05	Risk management training of leaders (top and middle management)	At least 90% of leaders trained in risk management.	Training Records: Documentation of attendance and completion of risk management courses by leaders.
RIE06	Awareness of the centre's professionals on the second victim phenomenon and resources available	At least a 60% of the institution's professionals should be aware of the existence of the second victim support intervention.	Institutional report.
RIE07	Trained peer supporters	The institution maintains a sufficient number of trained peer supporters to ensure accessibility and responsiveness within 24 hours of activating the support system, as determined by a validated assessment of required capacities. Trained peer supporters have been stratified by unit and professional category, including residents as a category in itself. The recommended minimum number of trained peer supporters is approximately 3% of the institution's staff, or about 1 peer supporter for every 10 professionals in the centre. This serves as a reference point rather than a strict requirement.	Staffing of peer supporters in the rapid response system of the second victim support intervention (updated annually). Record of professionals who have completed the institution's training plan as peer supporters. Evaluation of time between activation of support system and first contact of peer with second victim.
RIE08	Confidentiality of the service	All peer supporters have signed the confidentiality agreement.	Commitment Agreement signed by Peer Supporters.
RIE09	Engagement of peer supporters to complete initial training and subsequent updates.	All peer supporters finish the initial training.	Training records of peer supporters.
RIE10 (CORE)	Ensure support availability	The number of first requests that experience a delay (more than 3 hours) in the provision of support to the second victim due to unavailability of resources do not exceed 5% of valid requests.	Activity records.
RIE11	Identification of mentors for peer supporters	At least 5% of trained supporters serve as mentors for other peer supporters.	Comprehensive list of mentors and peer supporters.
RIE12	Commitment and support of the centre’s management	Senior and middle management participate annually in two or more activities/meetings related to the second victim support intervention.	Minutes of meetings between the management and those responsible for the second victim support intervention.
RIE13	Response latency (first level of attendance)	At least 90% of support requests that meet the assumptions for intervention activation should be addressed within 72 hours.	Records of activation requests for support intervention.
RIE14	Recommended interview times to support the second victim (e.g. 30-60 minutes for the first encounter).	Average duration of initial interviews should be a minimum of 30 minutes.	Activity records.
RIE15	Referral of the second victim from peer support team (level 3) to specialised/structured support (levels 4 and 5)	All second victims whose clinical condition worsens over time, despite being supported by trained peers (level 3), receive a proposal for referral to specialised support resources (levels 4 and 5) by the intervention's referral protocol.	Activity records.
RIE16	Involvement of the second victim in the search for solutions	At least 75% of the action plans for the prevention of adverse events involving second victims have offered their participation in the search for solutions.	Activity records.
RIE17 (CORE)	Suicide risk code in the second victim	Validated suicide risk assessment instruments are in place. No cases of suicide in second victims who have accessed the support intervention.	Follow-up records for second victims.
RIE18 (CORE)	Transparency of patient safety incident management	The first victims' needs and rights are respected. Open disclosure is conducted.	Activity records.
RIE19 (CORE)	Peer supporters receiving support	All peer supporters complete an experience evaluation form after each support encounter with a second victim. Those who require assistance from their mentor or colleagues receive the necessary support promptly.	Experience evaluation data. Activity records.
RIE20	Follow-up to the second victim	For all of second victims who receive the support intervention and inquire about or accept follow-up, additional support is offered three months later. This follow-up can be extended quarterly for up to one year or further, upon the request of the second victim.	Anonymized records of second victims' follow-up.
RIE21	Assessing psychological distress in second victims.	In ≥60% of second victims who received the support intervention, psychological distress symptoms decreased by the end of the intervention compared to their levels at the time of activation.	Responses to validated questionnaires to assess second victim response (e.g. The Second Victim Experience and Support Tool, SVEST).
RIE22	Long-term psychological effects in the second victim.	≤5% of second victims who received the support intervention have severe psychological sequelae one year later that may result in a loss of human value for the health institution.	Follow-up records for second victims.
RIE23	Working days lost.	The number of working days lost by second victims who received the support intervention is periodically evaluated, with improvements implemented as needed.	Seek leaves reports.
RIE24	Appropriate spaces for debriefings	The use of the designated debriefing spaces is monitored, with records kept of the frequency and purpose of their use.	Activity records.
RIE25	Information about second victims approach is accessible to all healthcare workers.	The organization has developed resources to ensure that any worker can access reliable information about the second victim phenomenon and learn how to address it. This information may be disseminated through platforms such as the intranet, digital platforms, or shared computer folders. This information also includes the results of the second victim support programme are communicated to health workers on a biannual basis.	Number of visits, downloads, etc., in proportion to the total number of professionals in the institution.

Advanced criteria

N	Name	Standard	Source
RIEA01	Safety culture based on Just Culture principles	A policy has been approved, and the application of Just Culture principles is discussed in the safety committee, with examples documented in the meeting minutes.	Just culture policy or protocol. Approval date and program follow-up records. Meetings minutes.
RIEA02	Systematic actions to prevent recurrence of clinical errors or system failures	In all situations where a professional is identified as a second victim, a detailed analysis is carried out and an improvement plan is generated.	Incident reporting systems. Internal and external reports on incidents. Assessments and audits: Assessments of the effectiveness of corrective actions and audits of risk management processes .
RIEA03	Institutional investment in prevention and self-care (levels 1 and 2 of second victim support)	Annually, the institution carries out at least two activities to prevent the second victim phenomenon and promote the self-care of its workers.	Institutional records on activities and events held (e.g., annual report of activities). Attendance and participation records.
RIEA04	Open channels for ongoing recruitment of peer supporters.	The frequency of outreach efforts and updates on recruitment opportunities is at least once per year.	Recruitment campaign reports.
RIEA05	Support modalities available for second victims (one-to-one and group support).	Both individual and group support have been applied in addressing the second victim phenomenon.	Activity record of the support resource specifying the number of encounters and the type of support (one-to-one or group) provided to the second victim.
RIEA06	Specific support protocol for residents as second victims	The support protocol adapted to the particularities of the second victim phenomenon in residents (staff of the institution who are still in training) has been implemented and is actively applied to ensure their inclusion in the intervention.	Figures on residents involved as peer supporters or supported as second victims.
RIEA07	Specific support protocol for student trainees/interns as second victims.	The support protocol adapted to the particularities of the second victim phenomenon in student trainees/interns has been implemented and is actively applied to ensure their inclusion in the intervention.	Figures on student trainees/interns supported as second victims.
RIEA08	Option to request a change of peer supporter.	A ≥95% of peer supporter change requests are addressed and resolved within 72 hours. A qualified Ethics Committee is in place to make collegial decisions to reject applications for second victim support in cases of non-compliance with the assumptions of the application.	Record of requests for change of peer supporter by second victims or users of the support intervention. Minutes of meetings of the Ethics Committee. Support request record.
RIEA09	Offering support outside of work.	A sufficient number of peer supporters are available to provide guidance and assistance to second victims on sick leave or absent from work, for those who require it. This number has been sufficient to meet the support demands of second victims who have not regularly attended work over the past 12 months.	Figures of support provided to second victims.
RIEA10	Accompanying the second victim back to work after sick leave/absence	At least 75% of second victims receive support or mentoring upon their return to work after sick leave or absence, if they choose to do so.	Figures of support provided to second victims.
RIEA11	Integration of a patient representative in the lead team for the second victim support intervention	A patient representative has participated in at least half of the planned sessions.	Minutes of the meetings.
RIEA12	Sustainability plan for the second victim support intervention.	Demonstrated operational continuity for a minimum of 3 years.	Institutional records, annual reports, program documentation, and evaluations conducted by the program's management team.

When multiple data sources are indicated, any one of them is considered valid.

Setting: hospital

Level: Comprehensive

RESCUE- Support Intervention Standards

Elementary criteria

N	Name	Standard	Source
RICE01	Safety culture based on Just Culture principles	Existence of a policy strategy to support just culture approved by the institution and it’s reviewed every 3 years.	Institutional policy document.
RICE02	Second Victims Strategy as part of the centre's strategic planning	The Second Victims Strategy is reviewed every 3 years.	Institutional policy document.
RICE03	Institutional policy to support second victims	The policy framework for supporting second victims is reviewed and updated at least every second year.	Institutional policy document on second victims’ support.
RICE04	Risk management training of leaders (top and middle management)	The implementation level of risk management across the various services within the institution is periodically evaluated, with data collected to measure its impact.	Annual assessment report.
RICE05	Awareness of the centre's professionals on the second victim phenomenon and resources available	The channels for sharing information about the second victim support policy and program are evaluated at least every two years, with improvements made to enhance their reach.	Annual assessment report. Minutes of meetings. Audience data.
RICE06	Institutional training for peer supporters	The training program is reviewed at least every two years. Changes, or the decision to maintain the current approach, content, and trainers, are justified.	Annual assessment report. Minutes of meetings. Trainees data.
RICE07 (CORE)	Referral protocol for second victims.	The referral protocol is reviewed at least every 3 years. Justified improvements have been implemented.	Referral procedure included in the Institutional peer supporter protocol document. Report of improvements identified and action plan.
RICE08 (CORE)	Transparency of patient safety incident management. Protecting patient rights.	The institution evaluates and improves its transparency practices in communicating with patients and/or their families about safety incidents. This includes regular assessments of how effectively open disclosure is applied.	Annual assessment report. Minutes of the meetings. Changes in the train program. Improvements plan/report.
RICE09 (CORE)	Monitoring the effectiveness and impact of the intervention	A dedicated scoreboard is used to monitor the effectiveness and acceptability of the intervention (e.g., using the following indicators¹: Awareness and Activation of the Program Support provided vs. activation requests. Support provided vs. SVs identified through reporting systems. HCWs aware of the second victim policy and support intervention vs. total HCWs. Processes and Structures Average time from incident to first encounter. Trained peer supporters vs. total peer supporters in the program. HCWs trained on second victim topics vs. total HCWs. Impact of the Program - Psychological distress levels before and after the program. - Perceived benefit by second victims after peer supporter encounters. - Second victim feedback on their experience (qualitative). - Working days lost due to emotional distress among program attendees vs. total days lost). When possible, at least 75% of second victims who receive the support intervention and assess the program under strictly confidentiality after completion the service express satisfaction with the support received and the performance of their assigned peer supporter.	Scoreboard. Evolution of data. Annual assessment report of the intervention.
RICE10	Suicide risk code in the second victim	No suicide at any time.	Suicide Code data.
RICE11	Peer supporters receiving support	At least 80% of those who receive follow-up support report improvements in their psychological well-being.	Annual assessment report of the intervention.
RICE12	Collaboration agreements with Universities, health professional training institutions to include aspects related to the phenomenon of second victims	The healthcare institution maintains ongoing collaboration with other organizations (e.g., disseminating information about second victims, participating in the training of peer supporters, or providing support to other institutions in this area) consistently over the past three years.	Verifiable list of activities.

Advanced criteria

N	Name	Standard	Source
RICA01	Support modalities available for second victims (one-to-one and group support).	The effectiveness of individual and group interventions is periodically monitored by the intervention leadership team and overseen by the institution's board of directors.	Minutes of the meetings. Annual reports. Scoreboard.
RICA02	Institutional investment in prevention and self-care (levels 1 and 2 of second victim support)	At least 25% of the staff participate annually in Level 1 and 2 activities focused on prevention and self-care.	Minutes of the meetings. Annual reports. Scoreboard.
RIEA03	Existence of wearables to detect affective symptoms, fatigue, etc. in second victims.	Regular evaluation of data collected by wearables to inform support strategies.	Records wearable technology.
RICA04	Specific support protocol for residents and student trainees/interns as second victims	The number of second victims from each of these groups is monitored to ensure that their specific needs are appropriately addressed by the intervention program.	Minutes of the meetings. Annual reports. Scoreboard.
RICA05	Offering support outside of work (e.g. always in case of sick leave)	The effectiveness of support provided to second victims who are absent from work (e.g., on sick leave or other absences) is periodically monitored. The intervention leadership team adjusts decisions based on the data to ensure tailored and effective support.	Minutes of the meetings. Annual reports. Scoreboard.
RICA06	Litigation and property claims associated with adverse events.	≤10% of adverse event cases in which the protocol for serious adverse events has been followed result in a claim or lawsuit against the healthcare professional or institution.	Registration documents of claims, complaints or lawsuits.

When multiple data sources are indicated, any one of them is considered valid.