The authors recognise that standardising the criteria used to recognise deterioration is only one part of the equation. The afferent limb of any rapid response system (the NZEWS) is only as good as its efferent response - who attends the bedside of the deteriorating patient. The response within a tertiary teaching hospital is clearly not possible in a small rural hospital. Although a NZEWS of a certain value should have the same physiological significance (& associated morbidity and mortality) from Invercargill to Auckland, it would be left to each individual institution to decide what level of activation they assign to increasing values (see figure 1. below).