title: A tragedy unfolds: lessons to learn.
authors.affiliation: jodom29373@aol.com
authors.forename: Jan
authors.initials: J
authors.lastname: Odom-Forren
mesh_terms: D000060:Accidents, Aviation / Q000517:prevention & control; D001291:Attitude of Health Personnel; D015984:Causality; D003142:Communication; D006804:Ergonomics; D006801:Humans; D007400:Interprofessional Relations; D019300:Medical Errors / Q000379:methods / Q000451:nursing / Q000517:prevention & control* / Q000523:psychology; D024802:Nurse's Role; D016528:Postanesthesia Nursing / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration*