Ms Orlaith Staunton:

At the outset, it came about through a group that was partly patient advocates, New York state and the hospital associations. Everybody had a voice. The state health commissioner said at the time that the Staunton family lost 25% of their family but that they were going to stop that and it was not going to happen again. The call came from him. The group asked how they could ensure that did not happen again and what the most important thing was. The most important thing was having established standards of care for when somebody shows up at an emergency room. Over 87% of people who get sepsis come through the emergency room in the hospital. At that time people thought it might be from IV lines or whatever. That is some of it but most people come through the emergency room. The most important thing was to identify and treat sepsis, and treat it rapidly. That was essentially what they needed to do. Because every hospital is different, they asked each hospital about it. They had a gold standard and asked the hospitals to submit the standards they thought would work for them. They did and then the state approved them. Of course, they also had to report on how their sepsis numbers were.

I am sorry, I forgot the second part of the Deputy's question. Was it about how they ensure they are trained?