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.

This certification adopts the ERNST Five-Level Framework for Second Victim Support1, and aligns with the principles and foundational statements declared by ERNST to effectively address the Second Victim Phenomenon .

Seys D, Panella M, Russotto S, Strametz R, Joaquín Mira J, Van Wilder A, Godderis L, Vanhaecht K. In search of an international multidimensional action plan for second victim support: a narrative review. BMC Health Serv Res. 2023;23(1):816.

Moreover, implementing Second Victim Support Programs has proven to be largely self-sustaining, as the direct cost savings from minimizing the impact on second victims and shortening their recovery process compensate for the required investment3. By reducing the long-term consequences associated with highly stressful events inherent to daily health and care practice, these programs not only enhance the well-being of professionals involved in patient care but also contribute to safer and more resilient healthcare environments , ultimately improving the quality of care and patient safety .

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.

Strametz R, Roesner H, Neusius T, Wiesenhuetter I, Bushuven S, Mira JJ, Hinzmann D, Heininger S. The Economic Implications of Psychosocial Peer Support for Health Workers in German Hospitals. J Healthc Leadersh. 2025 Jan 25;17:15-22.

By setting clear criteria and benchmarks, RESCUE-Intervention enables institutions to guarantee the adequacy of the Second Victim Support Interventions. This framework fosters recovery and resilience while promoting safer and more supportive environments for health and care professionals.

When using this certification guide, the specific setting (hospitals, primary care facilities, or long-term care settings, including nursing homes and social-healthcare centers) must be selected, as the criteria may vary depending on the context.

This certification encompasses institutions that have designed their intervention, have firmly implemented support interventions, and completed at least one evaluation and improvement cycle.

RESCUE-Intervention Certification Standards are divided into two levels:

Elementary criteria (RIEL01 to RIEL17): Establishes fundamental standards for implementing and executing the Second Victim Support Intervention. It includes institutional policies, staff education on the Second Victim Phenomenon, Codes of Conduct, Peer Supporter training, immediate emotional support, referral protocols, resource availability, and periodic policy reviews. It also promotes a culture of openness to reduce stigma and encourage seeking help.
Advanced criteria (RIAD01 to RIAD12): Defines advanced standards, including institutional policies to enhance transparency, patient safety, and long-term sustainability. It promotes Just Culture, prevention of emotional exhaustion of high-risk groups, specific support for residents and students, and non-permanent staff, comprehensive monitoring and evaluation systems to assess intervention effectiveness and guide continuous improvement, and collaboration frameworks with universities and training institutions to integrate Second Victim awareness into education

Overall, these standards ensure that interventions align with advancements and developments established by sector leaders, supporting recovery and fostering resilience to face future highly stressful events.
These standards result from a collaborative effort by an international team that is part of the Innovative Grant IG19113 funded by COST. They are designed to align with the principles on the Second Victim Phenomenon established by ERNST .

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

Procedure

The candidate designates a contact person responsible for submitting the application on behalf of the institution. This individual conducts a self-assessment to determine the institution´s positioning within the certification system. Once the institution is deemed ready to apply for certification at either level, the application is submitted. To complete the application, the candidate must upload the self-assessment results and supporting evidence demonstrating compliance with each standard on the platform.

The auditor reviews the institution´s self-assessment results, verifies the supporting documentation, and proceeds with the 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.

Elementary Certification: Covers standards classified as elementary.
Advanced Certification: Includes additional standards classified as advanced. To obtain Advanced Certification, institutions must meet the criteria for Elementary Certification in addition to 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 Second Victim Support Intervention’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.
The support application's algorithm facilitates the correct implementation of this instruction.
- Example: The commitment to the Second Victim Support Intervention’s Code of Conduct is signed by all peer supporters and the institution's leadership, when at least 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 Second Victim Support Intervention’s Code of Conduct is only signed by 55% of all peer supporters and the institution's leadership and this can be verified.

Elementary certification is granted if all CORE standards are met and at least 12 out of 14 non-CORE standards are full compliance. Advance Certification is granted if at least 10 out of 12 standards are fulfilled. Failure to comply with a CORE standard means that the intervention cannot be certified at this time.