Question: If a doctor is someone who can assume care of a VSA patient and decide to have resuscitative efforts ceased, then why is a doctor not someone who counts as a witness in the 'unwitnessed arrest' condition of a TOR, along with paramedics and firefighters? Thanks in advance.
Great question! The concept of EMS witnessed arrests has less to do with the level of training of the witness and more to do with the timing of the arrest itself.
We know that if EMS witnesses the cardiac arrest, that patient has a much higher likelihood of achieving a return of spontaneous circulation (ROSC) than non-EMS witnessed cardiac arrest victims. It has a lot to do with time. Often these EMS witnessed patients are either already enroute or about to begin the transport phase and have immediate access to life saving resuscitative efforts by paramedics.
That is the reason that these patients are excluded from the TOR: it is a timing and ROSC issue not a training issue. If a physician witnesses a cardiac arrest, chances are they are either in their office or clinic and EMS still has to respond. Alternatively, the physician may be just present by chance as a member of the public and the same response time interval for EMS to arrive is present which unfortunately decreases the likelihood of successful ROSC.