How to draw a Genogram

Cite this article as:
Daniel Bakhsh. How to draw a Genogram, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.17132

As a Student Doctor at the University of Queensland, I was offered the opportunity to shadow the Adolescent Team at The Child and Youth Mental Health Service (or CYMHS) at the Queensland Children’s Hospital. This was an amazing opportunity to observe some really important work in two of my special interest areas: Paediatrics and Psychiatry. The attachment really drove home that patients don’t exist in isolation, and how this is particularly true for children. The surrounding family system strongly dictates how well they will fare once they leave the hospital.

As part of this attachment I was asked to prepare and present Genograms for every patient at the weekly Multidisciplinary Team meeting. As I began to interview family members in order to gather the required 3 generations of family history, it became clear to me that a small diagram could represent and quickly convey what would otherwise have taken several pages of text. Genograms provide a wealth of insight at a glance, can help align patients with their most appropriate care, and are relatively easy to draw once you know how. They are a mainstay of Paediatrics for a reason.

When I first came across Genograms as a student, attempting to create one was very confusing and a little overwhelming. There are also surprisingly few reference materials available to aid you along the way. So in order to make this task a little easier for the next student, I put together this little video. I hope you find it useful.

– Daniel Bakhsh, Student Doctor, Doctor of Medicine Program, University of Queensland

DFTB go to New York

Cite this article as:
Andrew Tagg. DFTB go to New York, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.17016

I first heard of the FemInEM crew in Dublin. Dara Kass, Jenny Beck-Esmay and Stacey Poznanski took to the stage to talk about the birth of FemInEM, first as a blog then as a resource to effect change in the conversation around gender and equity in emergency medicine. Since then they have grown to be a leading voice in this area.

Their first sell out conference, FIX17, in New York brought together a unique set of voices and when the call came out for pitches to speak at FIX18 I thought it would be the perfect place for me to tell a story. This blog post isn’t about my tale – you can read A short story about deathand life here – but about something else.

I consider myself well-travelled, having spent almost 5 years of my life working as a doctor on board cruise ships, but hearing the talks at FIX18 made me realise I a still living in my own little bubble. Everything I hear via Twitter or other forms of social media comes pre-filtered by the source. So if I only follow white hetero-males they inform my worldview. The conference reminded me that there are other voices and other realities.

 

Sex and gender

In a conference where I was clearly in the minority, I was constantly reminded of things I have just taken for granted. Nick Gorton, a transman,  really opened my eyes when he told the audience that life had been like playing a video game on hard mode then, when he became a man, everything just switched over to easy. Look out for his great talk when it comes out…

 

Race

You only have to read the newspaper headlines on any given day to see how race plays a role in the public perception of a person. To hear Arabia Mollette say that she will never be seen as a woman first when she walks into a room because she is a person of colour made me feel uncomfortable. I’d like to think that I don’t see the world that way, but we all have our implicit biases. Don’t think you are biased? Then try out one of the Harvard Implicit Bias tests over at Project Implicit.

 

Privilege

A lot of medics come from a place of privilege, parents with degree level education and jobs that pay well. Many have parents that are, or were, doctors.  Regina Royan spoke of a different type of upbringing, of families struggling to make ends meet, and of the hidden challenges this brings from the start of medical training – not just in the shockingly high costs to apply to medical school in the US but also on things like electives and placements away from your home base.

 

I have lived, comfortably, within my own little bubble of existence. FemInEM has challenged me to expand my worldview, to listen to dissenting voices, and ask more questions.

 

For more accounts of FIX18 then read these accounts…

Penny Wilson – Getting my feminist FIX in New York

Shannon MacNamara – Telling stories to FIX things

Annie Slater – We support, We Amplify, We Promote

 

A short story about death…

Cite this article as:
Andrew Tagg. A short story about death…, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16636

This is the first of a two-part post based on my talk for FIX18 entitled A short story about death and life… We’ll publish the second part tomorrow.

 

“Someone will be along in a minute to explain what is going on”

Then a minute became two, three, five, until fifteen silent minutes had passed, each one seemingly longer than the last. Then footsteps…

It must have taken her an hour to cross the floor, or maybe just 30 seconds, I don’t know. I was no longer there.

I’m sorry, Mr. Tagg, I’ve got some bad news for you….Despite our best efforts, we were unable….

Her words disappeared and floated away with our dreams and I was lost.

That was how I had found out that my daughter had died. It was a tragic accident, the result of an unexpected antepartum haemorrhage and  an unsuccessful neonatal resuscitation. Something happened that day that fundamentally changed me, not just as a person, but as a doctor.

Flashbulb memories

Memory is imprecise – even in times of extreme emotion when it feels like every frame is burnt into your retina like the after image of photograph. These flashbulb memories have been heavily studied by psychologists and Malcolm Gladwell gives an easy to understand rundown in this episode of Revisionist History. What is most fascinating to me is that they are not always correct. So what does that mean of my recollection of the events that August?

The rarity of neonatal resuscitation

According to the Australian Bureau of Statistics a baby is born every 1 minute 42 seconds. That equates to around 8000 babies a day. Unfortunately, 7.2 per 1000 babies are stillborn and there are 2.4 neonatal deaths per 1000 live births. So in the whole of Australia, there are up to 19 neonatal deaths every single day.*

Most of us attend a delivery and never expect to resuscitate an infant. When we do a waft of oxygen is often all that is required. A Dutch study showed that around 2.6% of all births via elective caesarean required supplemental oxygen, around 1% require bag-valve-mask ventilation of some sort and only 0.1% require any more intensive resuscitation. The rates are much higher in lower/middle income countries.

Because they are such a rare event most doctors never expect to have to deal with a fatal outcome. Just as most emergency physicians obsess over the rarest of events, the surgical airway, perhaps those of us that may potentially be present at birth should be prepared to do what is necessary?

*A neonatal death is one that occurs within 28 days of birth

 

Absence does not make the heart grow fonder

A lot has already been written about the benefits and challenges of parental presence during the management of a critically ill child. To get you up to speed then read this post from Natalie May over on St Emlyns. The Resuscitation Council (UK) seems to think it is a good idea and most literature focuses on parental presence in either the ICU or ED setting and in an older cohort.

An exploratory interview study by Harvey and Pattison identified four key concerns surrounding the presence of the father during neonatal resuscitation in the delivery suite.

  • Whose job is it to support them?
  • What should they say or do?
  • The importance of teamwork
  • Impact on the healthcare practitioner

Think about the last time you did any neonatal life support training? No doubt you focussed on the core clinical skills – airway, breathing, circulation – with very little if no mention of dealing with the parents.

Medicine has moved on from beneficient paternalism to a more patient/parent-centred approach. It can be a hard decision to make – stay or go – but it doesn’t have to be the clinician’s choice.

Being present at a neonatal resuscitation can also be distressing for the staff involved and so one can understand how medical teams might want to shield parents from the hurt. There is concern that caregivers might interfere or get in the way with treatment. A skilled guide, such as a social worker or trained nurse, can help explain what is going on and translate the complex medical into plain English.

 

‘They’ll always remember how you made them feel”

In a time when infant death was a common occurrence, the prevailing thought was that grief could be avoided by preventing mothers from seeing their stillborn children. Psychologists would later theorize that an attachment bond had not been formed and so whisking the baby away without ceremony would cause no harm. By the 1970s this theory had been thrown out the window and grieving parents were offered the opportunity to see their children. Perhaps now the attachment bond is formed even earlier, through the use of antenatal screening, regular ultrasound scans and midwife visits making grief even more palpable.

 

The traditional (if flawed) Kubler-Ross model of grief

There will always be questions after an unexpected death – some can be answered and some can never be. But is important for parents to have the opportunity to ask. A qualitative study by Bakhbahki and colleagues in the South West of England identified a number of parental concerns centred around the framework of transparency, flexibility, inclusivity, and positivity.

We want to know that there is a perinatal mortality review process and how it works. As one of the interviewed stated, they wanted to know “this is how your child died and this is how we investigate it“. Parents wanted to know that this process was multidisciplinary involving not just neonatologists or paediatricians but also the obstetricians in order to identify any factors that may future tragic events.

We want our children to be treated like any child should be treated – with respect – regardless of whether they are alive or dead.

“The most distressing thing for me was knowing that she had been stripped of her blanket and photographed before I even had the chance to hold her.”

E.T. – a bereaved mother

There is a stigma attached to the death of a child. Society, whether it means to or not, sees the death of a child as a failure on the part of the mother. She must have done something wrong in pregnancy, she must have broken the rules. Then, these women are isolated from other newborns and their parents to the extent that they may even receive sub-optimal care.

An alternate view

It has been 8 years now and I have progressed far enough in my career to be the one bearing bad news. As an emergency physician who deals with a lot of sick and critically unwell adults, I have gone out of my way to seek formal training on breaking bad news. Specialties, such as obstetrics and paediatrics, are not exposed to death and dying on such a routine basis and very few have received formal training.

So what could be done better?

Whilst being an emotionally distant automaton may afford some protection for the clinician it is important that those breaking bad news are humans first, doctors second. I’ve written before about the power of kindness and this is one of those moments when we need to stop, look, listen and think. The death of a child, any child, is a devastating event and should be acknowledged as such.

 

With thanks to Tess (for letting me share our story) and my big-hearted cheer squad (Tessa, Ben, Henry, Tanya, Genevieve, Ian, and Ross)

Selected References

The rarity of neonatal resuscitation

*De Luca R, Boulvain M, Irion O, Berner M, Pfister RE. Incidence of early neonatal mortality and morbidity after late-preterm and term cesarean delivery. Pediatrics. 2009 Jun 1;123(6):e1064-71.

Kerber KJ, Mathai M, Lewis G, Flenady V, Erwich JJ, Segun T, Aliganyira P, Abdelmegeid A, Allanson E, Roos N, Rhoda N. Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby. BMC pregnancy and childbirth. 2015 Dec;15(2):S9.

Knight M, Draper ES, Kurinczuk JJ. Key messages from the UK Perinatal Confidential Enquiry into term, singleton, intrapartum stillbirth and intrapartum-related neonatal death 2017.

Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, Paul VK, Pattinson R, Darmstadt GL. Two million intrapartum‐related stillbirths and neonatal deaths: where, why, and what can be done?. International Journal of Gynecology & Obstetrics. 2009 Oct 1;107(Supplement):S5-19.

Lee AC, Cousens S, Wall SN, Niermeyer S, Darmstadt GL, Carlo WA, Keenan WJ, Bhutta ZA, Gill C, Lawn JE. Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect. BMC public health. 2011 Dec;11(3):S12.

Richmond S, Wyllie J. European resuscitation council guidelines for resuscitation 2010 section 7. Resuscitation of babies at birth. Resuscitation. 2010 Oct 1;81(10):1389-99.

Wilmink FA, Hukkelhoven CW, Lunshof S, Mol BW, van der Post JA, Papatsonis DN. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. American journal of obstetrics and gynecology. 2010 Mar 1;202(3):250-e1.

Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation. 2015 Oct 1;95:249-63.

 

Absence does not make the heart grow fonder

Boie ET, Moore GP, Brummett C, Nelson DR. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of 400 parents. Annals of emergency medicine. 1999 Jul 1;34(1):70-4.

Cacciatore J, Rådestad I, Frederik Frøen J. Effects of contact with stillborn babies on maternal anxiety and depression. Birth. 2008 Dec;35(4):313-20.

Fulbrook P, Latour JM, Albarran JW. Paediatric critical care nurses’ attitudes and experiences of parental presence during cardiopulmonary resuscitation: a European survey. International journal of nursing studies. 2007 Sep 1;44(7):1238-49.

Harvey ME, Pattison HM. The impact of a father’s presence during newborn resuscitation: a qualitative interview study with healthcare professionals. BMJ open. 2013 Jan 1;3(3):e002547.

Nederstigt I, Van Tol D. Parental presence during resuscitation. Resuscitation. 2008 May 1;77:S61.

Offord RJ. Should relatives of patients with cardiac arrest be invited to be present during cardiopulmonary resuscitation?. Intensive and Critical Care Nursing. 1998 Dec 1;14(6):288-93.

Sawyer A, Ayers S, Bertullies S, Thomas M, Weeks AD, Yoxall CW, Duley L. Providing immediate neonatal care and resuscitation at birth beside the mother: parents’ views, a qualitative study. BMJ open. 2015 Sep 1;5(9):e008495.

Tripon C, Defossez G, Ragot S, Ghazali A, Boureau-Voultoury A, Scépi M, Oriot D. Parental presence during cardiopulmonary resuscitation of children: the experience, opinions and moral positions of emergency teams in France. Archives of disease in childhood. 2014 Jan 6:archdischild-2013.

 

‘They’ll always remember how you made them feel”

Badenhorst W, Riches S, Turton P, Hughes P. The psychological effects of stillbirth and neonatal death on fathers: Systematic review. Journal of Psychosomatic Obstetrics & Gynecology. 2006 Jan 1;27(4):245-56.

Bakhbakhi D, Siassakos D, Burden C, Jones F, Yoward F, Redshaw M, Murphy S, Storey C. Learning from deaths: Parents’ Active Role and ENgagement in The review of their Stillbirth/perinatal death (the PARENTS 1 study). BMC pregnancy and childbirth. 2017 Dec;17(1):333.

Bonanno GA, Kaltman S. The varieties of grief experience. Clinical psychology review. 2001 Jul 1;21(5):705-34.

Boyle FM, Vance JC, Najman JM, Thearle MJ. The mental health impact of stillbirth, neonatal death or SIDS: prevalence and patterns of distress among mothers. Social science & medicine. 1996 Oct 1;43(8):1273-82.

Flenady V, Boyle F, Koopmans L, Wilson T, Stones W, Cacciatore J. Meeting the needs of parents after a stillbirth or neonatal death. BJOG: An International Journal of Obstetrics & Gynaecology. 2014 Sep;121:137-40.

Flenady V, King J, Charles A, Gardener G, Ellwood D, Day K, et al.PSANZ Clinical practice guideline for perinatal mortality. Perinatal Mortality Group https:// www.psanzpnmsig.org.au. Perinatal Society of Australia and New Zealand, April 2009; Vol. Version 2.2.

Koopmans L, Wilson T, Cacciatore J, Flenady V. Support for mothers, fathers and families after perinatal death. Cochrane database of systematic reviews. 2013(6).

Mills TA, Ricklesford C, Cooke A, Heazell AE, Whitworth M, Lavender T. Parents’ experiences and expectations of care in pregnancy after stillbirth or neonatal death: a metasynthesis. BJOG: An International Journal of Obstetrics & Gynaecology. 2014 Jul 1;121(8):943-50.

Nuzum D, Meaney S, O’donoghue K. The impact of stillbirth on consultant obstetrician gynaecologists: a qualitative study. BJOG: An International Journal of Obstetrics & Gynaecology. 2014 Jul 1;121(8):1020-8.

 

Are there too few women presenting at paediatric conferences?

Cite this article as:
Davis, T. et al. Are there too few women presenting at paediatric conferences?, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16879

Sometimes we have a great idea for a paper but try as we might we cannot get it published in the traditional way. So what better means of disseminating knowledge than publishing it right here, on the Don’t Forget the Bubbles website? Given that this is the week of FIX18, the Feminem Idea eXchange, it seems like there is no better time like the present to discuss female presenters at paediatric conferences.

Securing funding for your research

Cite this article as:
Siobhán McCoy. Securing funding for your research, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16834

Money, makes the world go round and the research world is no different. Funding is a key element which can potentially stand in the way of making our research proposal a reality. My experience, along with anecdotal evidence from colleagues would suggest that, the quest for funding remains the toughest part to getting you research project off the ground.  In my career I have, however, been very lucky to meet a number of great clinical researchers and in doing this I have gleaned some tips and tricks from the best in the business.

In the following section I have outlined a few tips which will hopefully help you in securing that elusive grant.

This is the third part in a series on research. The previous articles are: choosing your research topic; and conducting your literature review.

  1. Take your time

These things have an awful habit of taking longer than you think they will, so be prepared and give it time. No matter how simple it seems in your head there are lot of different elements to pull together and some will be more time-consuming than others when it comes to proposals and grant writing.

 

  1. Choose your funder and scheme carefully

It can’t hurt to speak to the funders – they are there to help. Remember if you don’t ask the question, how will you know the answer? Asking questions allows you to gain insight into what the funder is interested in. Sign up for information feeds, find out what kind of research is in a funder’s remit and read through guidance and eligibility criteria carefully. This will reduce the chance of you applying for an inappropriate scheme/grant/funding source, which is a waste of your time and theirs.

 

  1. Source advice from people in the know

Chat to people in the know. Collaboration is king when it comes to grants and funding, therefore it is important to create a collaborative network within your department, hospital or speciality. Speak with your grants office, mentors and colleagues who have served on funding panels. Getting involved in grant writing at an early stage is a good idea, if only as an observer. Finding out how senior colleagues collate ideas, assemble teams and develop an application will be valuable to you going forward.

 

  1. Have a plan A, B & C

Plan your application and take your time, don’t rush it. Go out and look for inspiration to help pull together an idea that’s worthy of being funded. The wider the range of ideas you can expose yourself to, the more interesting concepts you’ll come up with.

 

  1. Building a good team

Creating the right team involves politics and a full reality check. The people involved in the proposal/application are just as important as the project you’re proposing. You need to make sure the skill mix is right. Identifying your strengths and weakness before you get started will allow you to single out a person/people who will add value to the team. You may have a strong background in methodology and study design but be useless at statistics, therefore you will need someone in your team with an aptitude for statistics.

Additionally, it is always helpful to have a senior colleague involved, potentially someone who has a good track record with funding/grants. By association these people add gravitas and can provide comfort to a funding body that you are someone who can be considered/trusted with a significant grant. The funding bodies will want to see that you have considered all aspects of the project process from inception to delivery, therefore, you must provide evidence that the team is capable of delivering what you propose and in turn validating the investment.

 

  1. You must propose solid objectives

Funders like to see that you have considered all the options. For you to be in with any chance of getting through an application board they need to see concise, specific aims and well-defined criteria to quantify success. It is important that you portray to the application board what it is that each experiment will deliver and how that aligns with your aims? Vagueness is your enemy here.

 

  1. Hypothesis – make it crystal clear

When it comes to your hypothesis, there is no place for ambiguity. Funders and your team need to see a clear and specific rationale for your work. They need to know what you are doing and why. You must convince the funder that the gap in the knowledge you have identified is relevant and that your study can fill or work towards filling it in your own unique way. It is ok to have an ambitious project, however, you must be able to explain why and convince funders that you have a fair chance of achieving your goal.

 

  1. Impact

The main question that is asked of every researcher in relation to their work/proposal is…so what? You need to be able to get your audience to see why your work will contribute to improving human health. You need to clearly and concisely explain the intended consequences of your work. Funders need to know who will benefit in the short, medium and long term. What are you going to do to increase the chances of your work reaching those people? Even if your proposal isn’t earth shattering you must be able to explain the pathway that links your work to improving human health.

 

  1. Baseline data

The panel need to see that you have invested in your proposal – if you can provide preliminary data validating your proposal it will reassure the panel that you are a good risk. The results of this preliminary work will also help to support the proposal and indicate to the panel there is more work to be done and their investment is valid.

 

  1. Tell a compelling story

This is your sales pitch. Identify the hook, a key feature/s that your proposal hangs on. The panel need a convincing, focused narrative – you have to imagine you’re selling an idea to an audience. Make sure that this narrative links each experiment to your main aims.

 

  1. The Maths part

Your Statistical Analysis Plan (SAP) is essential as the panel need to see you have considered your data analysis from the outset. You should always engage your statistician from the beginning of the study design process. They help you establish your data collection methods, justify your sample size and identify appropriate statistical tests. It is important to get your sums right, lack of conviction in this section makes the funding panel uneasy. Use the right tools in the right way.

 

  1. Get a second pair of eyes

Get a second opinion from a mentor or a senior colleague. Proof read, spell check and stick to specified formats – remember the little details count. Presentation, punctuation, sentence syntax and grammar set the tone for how people feel about your work – they do matter. Remember only provide the information the application specifies.

For example: if the applications ask for a publications list (max 10 publications), only provide 10 of the most recent/relevant publications. If you don’t it shows lack of attention to detail.

 

Topics for clinical research for the most part are driven by what we as clinicians encounter in our daily working lives. Passion is no doubt an essential element in what drives us forward in clinical research and helps us to keep going when we hit a bump in the road. Despite our passion and drive we cannot produce robust, ethical and clinically significant research with this alone.

Tell me a story…

Cite this article as:
Team DFTB. Tell me a story…, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16484

“He held up a book then. “I’m going to read it to you to help you relax.”

“Does it have any sports in it?”

“Fencing. Fighting. Torture. Poison. True Love. Hate. Revenge. Giants. Hunters. Bad men. Good men. Beautifulest Ladies. Snakes. Spiders… Pain. Death. Brave men. Cowardly men. Strongest men. Chases. Escapes. Lies. Truths. Passion. Miracles.”

“Sounds okay,” I said and I kind of closed my eyes.”

William Goldman, The Princess Bride

Tim Horeczko: Towards A Calmer Resus at DFTB17

Cite this article as:
Team DFTB. Tim Horeczko: Towards A Calmer Resus at DFTB17, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16235

This talk was recorded live during the final plenary session of DFTB17 in Brisbane. If you missed out in 2017 then you can check out our YouTube channel to watch any of the talks.

Ross Fisher: What surgeons wish you knew from DFTB17

Cite this article as:
Team DFTB. Ross Fisher: What surgeons wish you knew from DFTB17, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16201

This talk was recorded live on the final of DFTB17 in Brisbane. If you missed out in 2017 then why not book your leave for 2018 now. Tickets are on sale for the pre-conference workshops as well as the conference itself at www.dftb18.com.

What more can be said about Ross Fisher that hasn’t already been said? Passionate presenter, good (but not perfect*) surgeon and friend to the stars – in this talk Ross delves into the hidden world of paediatric surgery.

Jesse Spurr: Safe Debriefing at DFTB17

Cite this article as:
Team DFTB. Jesse Spurr: Safe Debriefing at DFTB17, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.15914

This talk was recorded live on the final of DFTB17 in Brisbane. If you missed out in 2017 then why not book your leave for 2018 now. Tickets are on sale for the pre-conference workshops as well as the conference itself at www.dftb18.com.

Jesse Spurr needs very little introduction. Other than being involved in two of the greatest conferences out there (SMACC and DFTB18) Jesse also is co-founder and Editor-in-Chief of Simulcast.

Paediatric Research Priorities

Cite this article as:
Andrew Tagg. Paediatric Research Priorities, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16058

In order to help us all keep up to date the DFTB team and friends scour a great many journals to fill the monthly edition of Bubble Wrap. Given the large volume of research already out there that has not made it from the journal to the bedside, the major research agencies have been trying to determine what we really want to know.

Natalie May: Everything Counts in Small Amounts at DFTB17

Cite this article as:
Team DFTB. Natalie May: Everything Counts in Small Amounts at DFTB17, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.15910

This talk was recorded live on the final day of DFTB17 in Brisbane. If you missed out in 2017 then why not book your leave for 2018 now. Tickets are on sale for the pre-conference workshops as well as the conference itself at www.dftb18.com.

Natalie May is one of the powerhouses behind that great British institution, St Emlyn’s. Having completed her emergency medical training in the UK she has moved to warmer climes and works as a Specialist in Pre-Hospital and Retrieval Medicine for Sydney HEMS as well as doing the odd job on the side for the local NETS service.