From “second victims” to “frontline warriors”: An alternative framework for supporting healthcare workers involved in adverse events, during the COVID-19 pandemic and beyond

The challenges faced by healthcare workers (HCWs) on the frontlines of the COVID-19 pandemic have been widely analogized to the experience of military service members, both in terms of general burnout and the mental health effects of frequent trauma exposure. This analogy has the potential to yield a wealth of science-based recommendations for addressing the pandemic’s psychological impacts on frontline HCWs, and in particular the challenge of helping HCWs cope with adverse events for which they bear some actual or perceived responsibility. As we will argue, the “second victim” framework that currently guides the medical system’s approach to supporting these individuals is misleading at best and harmful at worst. This paper suggests an alternative, more agentic framework for supporting these HCWs—one that normalizes the acknowledgement, emotional processing, and active remediation of errors as part of what it means to exemplify the core values of a healer. Drawing on psychological research with military personnel and other trauma survivors, we summarize the key principles of this alternative framework, and we recommend strategies that medical facilities can adopt to help HCWs cope more resiliently with errors and adverse events during the pandemic and beyond.