Pearson agrees there may have been some “anchor bias” in which health-care workers appeared to rely on assessments of previous health-care workers, reducing concerns about her worsening condition. 

A sepsis prompt card for paramedics is shown at the inquest. It has criteria used to help identify a possible infection. They include temperature at or above 38 C, and at or below 36 C, a pulse at or above 90 beats per minute, and a respiratory rate at or above 20 breaths per minute. 

It also has criteria such as low blood pressure and mottled skin.

Skin cellulitis, low alertness, vomiting, shortness of breath, diarrhea with a history of fever or rigours, cough, abdominal pain and changes to urine are among possible signs of infection, the card says.

Sim notes IV drug use is now used by Niagara Health as a risk factor for sepsis. Pearson agrees the EMS sepsis card could be updated to include that.