Background
The implementation of structured support programs for health care workers affected as second victims remains highly variable across health care settings. Although several pioneering initiatives exist, a standardized, evidence-based certification framework to guide institutions in designing, implementing, and sustaining these interventions was lacking in Europe.

Objective
This study aimed to develop a standardized certification system for second victim support interventions and to pragmatically validate its feasibility, clarity, evidence sufficiency, and audit operability across hospitals, primary care, and long-term care settings.

Methods
A qualitative study was conducted. The RESCUE certification framework was developed using a structured, multiphase process informed by Framework Analysis. The process included a literature review, expert consensus, feasibility assessment, pilot testing, and refinement. Experts from 20 countries participated in the development and validation of the standards, ensuring alignment with diverse health care contexts and national regulations. Two certification tracks were defined: support interventions and peer supporter training.

Results
Iterative consensus and pilot feedback reduced overlaps, removed items with low feasibility or regulatory conflicts, and specified auditable evidence, resulting in 30 intervention standards and 11 training standards for second victim support interventions, categorized into elementary and advanced levels. Pilot testing in nine institutions across six countries indicated the feasibility, clarity, and applicability of the standards and audit procedures. Stakeholders reported that the certification promotes institutional commitment, enhances program sustainability, and contributes to a safer work environment.

Conclusions
RESCUE certification provides a structured, adaptable, and feasible framework for second victim support interventions in Europe. It fosters organizational learning, reinforces a Just Culture, and strengthens the resilience of health care professionals, ultimately contributing to workforce well-being and patient safety.