* Abbreviation: EWS — : early warning system Anticipating clinical deterioration and possibly averting it makes good sense. Early warning systems (EWSs) are designed on this premise. They have several components: (1) a numerical score derived from a clinical monitoring sheet with sections blocked off in colors (usually red, orange, and green) to indicate the seriousness of the sign and the score it should be given; (2) this score must elicit an action, such as increasing the monitoring frequency or calling a senior resident and/or attending for assistance; (3) a rapid response to that call; and (4) appropriate action taken. “Track and trigger” is a term used to describe the overall plan.1 EWSs are now used routinely on many hospital wards in well-resourced settings.2 Scoring systems were developed in single hospitals, and so there is a great diversity of systems. Some scores are binary, and others are color coded; some have opted for simplicity and ease of use by using fewer indicators, and others are time consuming with a large number of indicators, including behavior and level of concern (including that of the family).2 In many instances, … Address correspondence to Elizabeth Molyneux, DSc, FRCPCH, FRCEM, Paediatrics and Child Health, Malawi College of Medicine, Box 360, Blantyre 3, Malawi. E-mail: emmolyneux{at}gmail.com