Why EMS providers are at risk of becoming a second victim

EMS providers face near-constant stress and tragedy which the profession can no longer ignore

It's not uncommon to read an EMS journal and learn about a provider who has taken their own life. Perhaps the suicide, or attempted suicide, of a co-worker has impacted you during your career. Unfortunately, depression and suicide among health care professionals traumatized by adverse events occur too often and touch many lives and organizations.

Kathy Wire, JD, MHA, CPHRM, Project Manager for the Center Patient Safety states, "Individual EMS providers are the backbone of the health care system. Their ability to respond by bringing their best to work every day is critical to effective care. Yet these individuals face stress and tragedy that few outside their world can imagine. If the industry ignores the mental health of individual providers, it will lose the best resources. Conversely, efforts to acknowledge the potential fragility and humanity of providers protect them and their patients."

Emotional care
How do we care for frontline EMS provider's emotional well-being? Most EMS organizations have access to employee assistance programs and critical stress debriefing programs that are designed to assist employees during their most critical hour of need. However, gaps are apparent immediately following the adverse event, when intervention/peer support could begin the healing process before the employee reaches a crisis level.

Historically, EMS leaders have worked hard to encourage injury prevention and promote the benefits of a balanced diet and regular exercise, but incidents which challenge a providers' emotional resiliency after an unexpected outcome are usually not discussed as openly. Much of this has to do with a culture of EMS providers not wanting to appear weak or vulnerable.

However, EMS providers rely on emotional resilience to help get them through the day. Accumulated stress or unanticipated events can take a toll on this emotional resiliency, leaving a provider susceptible to depression and self-doubt as an EMS professional. When this happens to a provider, they become a second victim of the event.

Second Victim intervention
CPS understands that health care is not just physically demanding, but also emotionally demanding. This places EMS providers at risk for becoming second victims. Therefore, CPS is including The Second Victim intervention in this report as an industry call to action.

What is the Second Victim? In today's health care settings, clinicians face a multitude of demands requiring personal resiliency that relies on emotional defenses to carry them through the workday. Sometimes an unexpected patient outcome intensifies the emotional aftershock making it impossible for the clinician to focus on the task at hand. If not addressed, the emotional suffering may be prolonged, resulting in self-doubt regarding their future as a health care professional. This emotional response has been described as the second victim phenomenon.

The Second Victim program was designed by health care providers for health care providers. It supports the provider at the unit level with a program that can be tailor-made for each organization. And lastly, it fills a gap in health care that of proactive support for the provider, before they leave the profession or worse, make a decision to take their life.

When patients suffer an unexpected clinical event, health care clinicians involved in the care may also be impacted and are at risk of suffering as a second victim. Understanding this experience and recognizing the need for supportive interventions is critically important.

Six risk factors that put a provider at risk to become a second victim:

  • Pediatric cases
  • Multiple patients with bad outcomes
  • Unexpected patient demise
  • Young adult healthy patient
  • Patient known to the staff
  • First death on their watch

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