FACTORY ESCAPE GAME

FACTORY ESCAPE GAME

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start

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THE MISSION

In the heart of Taiwan's industrial landscape lies a town shrouded in mystery, where the rhythmic pulse of machinery has been disrupted by an unseen force – the NeuroPulse Syndrome. As a team of elite investigators, you receive a cryptic distress call to uncover the truth behind this enigmatic crisis. In early October 1986, a physician at the National Taiwan University Hospital was contacted concerning a possible outbreak of a neurologic illness among workers employed at a printing factory in Chang Hwa City, located 150 miles from Taipei, Republic of China. Seven of the plant’s 40 workers had reportedly become ill between September 28 and 30 with ona or more of the following signs and symptoms: ptosis, diplopia, difficulty swallowing, slurred speech, proximal muscle weakness, and dyspnea.

THE base

SEARCH THE ROOM FOR CLUES

Additional questions to ask related to OPERATIONAL ISSUES

FILL IN THE BLANKS

What has already __________ ? Who else is ___________

spread

been done

happened

been done

involved

quarantined

infected

involved

CODE 1

Additional questions to ask related to the DIAGNOSIS and CLINICAL FEATURES

FILL IN THE BLANKS

virus

illness

infection

How severe was the __________ ? Have there been any ________ cases What studies have been performed on the patients and what type of ______________ have been collected? Who evaluated the ________ and what is his/her diagnosis? Were any of the workers _____________?

illness

strange

serious

fatal

fatal

tests

sample

specimen

specimen

clients

patients

workers

patients

sick

hospitalised

infected

hospitalised

19

CODE 2

Additional questions to ask related to TIME, PLACE, AND PERSON might include:

FILL IN THE BLANKS

virus

cases

infection

Are _______ continuing to occur? ? Have additional workers become ill after the _______________? What do the workers do in the__________ ? Are any ________ members ill? Are there other cases in the _____________?

cases

first patient

original group

strange

original group

facotry

field

plant

plant

factoy

family

workers

family

factory

community

clinic

community

CODE 3

Additional questions to ask related to POSSIBLE ETIOLOGIES might include

FILL IN THE BLANKS

area

location

plant

Have there been any unusual events in that _______ chemical spills, mechanical breakdowns? Have there been any _________ changes at the plant? What types of ____________are used at the plant?

plant

unusual

recent

strange

recent

methods

chemicals

machines

chemicals

CODE 4

$CODE$

CORRECT

1. pass: 11957
2. gap: 45

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Find the clue you need to keep moving forward

THE base

Review the broad categories which are likely to cause acute disease outbreaks

Question 1/3

Choose the correct answer

Review the broad categories which are likely to cause acute disease outbreaks

Question 2/3

Choose the correct answer

Review the broad categories which are likely to cause acute disease outbreaks

Question 3/3

Choose the correct answer

Please match the steps of an outbreak to the right definition

STEP 6

STEP 4

STEP 1

Identify and count cases. • Widen net tactive case finding). • Create a case definition. • Develop a line listing.

Prepare for field work. • Contact necessary local authorities

Verify the diagnosis. • Interview the cases in order to find other cases and develop initial hypotheses

STEP 2

Descriptive epidemiology: Characterize the cases and the population at risk by tabulating and orienting the data in terms of time, place, and person.

STEP 8

STEP 5

STEP 3

STEP 7

Generate plausible. testable hypotheses regarding source, mode of transmission, risk factors..

Analytic epidemiology: Test hypotheses with case-control studies or other methods.

Confirm the existence of an epidemic.

Conduct additional studies as necessary.

Implement and evaluate control and preventive methods.

STEP 9

Document what you have done and report to public health community, physicians, and the public.

STEP 10

Characteristics of 7 Cases of Botulism Chang-Hwa City› September 28-30, 1986 CASE 1

Return

diplopia

Onset

Ptosis

9/28

Weakness

dysphonia

dysphagia

Hospitalized

Dyspnea

Next

Characteristics of 7 Cases of Botulism Chang-Hwa City› September 28-30, 1986 CASE 2

Return

diplopia

Onset

Onset

Ptosis

9/28

Weakness

dysphonia

dysphagia

Hospitalized

Dyspnea

Next

Characteristics of 7 Cases of Botulism Chang-Hwa City› September 28-30, 1986 CASE 3

Return

diplopia

Onset

Ptosis

9/29

Weakness

dysphonia

dysphagia

Hospitalized

Dyspnea

Next

Characteristics of 7 Cases of Botulism Chang-Hwa City› September 28-30, 1986 CASE 4

Return

diplopia

Onset

Ptosis

9/29

Weakness

dysphonia

dysphagia

Hospitalized

Dyspnea

Next

Characteristics of 7 Cases of Botulism Chang-Hwa City› September 28-30, 1986 CASE 5

Return

diplopia

Onset

Ptosis

9/29

Weakness

dysphonia

dysphagia

Hospitalized

Dyspnea

Next

Characteristics of 7 Cases of Botulism Chang-Hwa City› September 28-30, 1986 CASE 6

Return

diplopia

Onset

Ptosis

9/29

Weakness

dysphonia

dysphagia

Hospitalized

Dyspnea

Next

Characteristics of 7 Cases of Botulism Chang-Hwa City› September 28-30, 1986 CASE 7

Return

diplopia

Onset

Ptosis

9/30

Weakness

dysphonia

dysphagia

Hospitalized

Dyspnea

Next

Case 7 Hospitalized N

Case 4 Dysphagia Y

Case 3Weakness N

1. FIND THE CLUES FOR THE CASE'S

Case 6 dysphonia Y

Case 6Weakness Y

Case 2 Hospitalized Y

Case 5Diglogia Y

Case 2 dysphonia Y

Case 4Weakness Y

Case 7 Dyspnea N

Case 7diplopia Y

Case 6Onset 9/29

Case 6Ptosis y

Case 3diplopia Y

Case 5Ptosis y

Case 3 Dysphaqia Y

Case 5 Dyspnea N

Case 2Ptosis y

Case 7Weakness Y

Case 3Onset 9/29

Case 6 dysphagia Y

Case 2 Dysphaqia Y

Case 2 Dyspnea Y

Case 1Onset9/28

Case 3 Hospitalized N

Case 6 Dyspnea Y

Case 7 dysphonia N

Case 2Ptosis y

Case 4Ptosis y

Case 4 dysphonia Y

Case 5Weakness Y

Case 4Onset 9/29

Case 2diplopia Y

Case 1 Dyspnea Y

Case 2Onset 9/28

Case 1diplopia Y

Case 4diplopia N

Case 3 dysphonia N

Case 5 Hospitalized Y

Case 5Onset 9/29

Case 4 Dyspnea N

Case 1Weakness Y

Case 1Ptosis y

Case 5 Dysphagia Y

Case 7Ptosis y

Case 4 Hospitalized N

Case 7Onset 9/30

Case 7 dysphagia N

Case 1 Dysphonia Y

Case 3 Dyspnea N

Case 1 Dsgphagia Y

Case 5dysphonia Y

Case 3Ptosis y

Case 6 Hospitalized Y

Case 2Weakness Y

Case 1 Hospitalized Y (DIED)

Case 6diplopia Y

Drag the magnifying glass to discover the HIDDEN CLUES

FIND THE HIDDEN CLUE TO MOVE TO THE NEXT PAGE

A case definition should include the following four elements: clinical and /or laboratory characteristics, time, place, and person. One possible case definition for this situation could be a person with acute onset of 2 or more signs and symptoms of cranial nerve dysfunction beginning on or after September 28 who work or reside in Chang Hwa City.

When the team visited tha factory, they learned that one of the seven patients was the cook who ran the factory cafeteria and had no direct occupational exposure to the factory. She was the most seriously ill of the seven and was unable to be interviewed since she was on a respirator. On the basis of this discovery and a clinical picture compatible with botulism, investigators thought that the most likely source was an improperly preserved food. The investigators developed a questionnaire which focused on meals aatan in the cafeteria on the 26th and 27th of September. These datas were chosen since all cases became ill between the 28th and 3Oth of September and the incubation period for botulism is between 12 and 36 hours. The data are summarized in Table 2 on the following

Next

THE MISSION

MAKE A TABLE REPRESENTING THE INFORMATION ABOUT THE PATEINTS/WORKERS THAT YOU HAVE GATHERED. IF YOU NEED CLUES, CLICK ON THE (i) ICON ON THE TOP RIGHT OF THE SCREEN.

- Fudged by Adding 0.5 to Each Call Breakfast Location on 26 or 27 September Among ill and Not-ill Factory Workers

MEASURE OF ASSOCIATION

The data in Table YOU CREATED represent the entire "universe" of factow workers. Therefore, we have a rewospective cohort study. The appropriate measure of association is a relative risk. Unfortunately, the relative risk cannot be calculated because the risk was O among the unexposed group. You can express the relative risk aS "unquantifiably large." However, to obtain a "quick and dirty" or "fudged• estimate of the relative risk, 0.5 can be added to each of the cells:

CALCULATE THE FUDGE RISK IN THE SPACE BELOW

Enter answer

26

the base

Nine food items were served at the breakfasts on September 26 and 27. These items included several commercially preserved canned foods and home-made preserved ginger. When the persons who had eaten breakfast on one of the two days were questioned about specific foods consumed, none of the food items was found to be significantly associated with subsequent illness. Some of the preserved ginger served at the zwo breakfasts was still available for testing. Although no left-overs or partiallv empty cans of the eight other items remained from the implicated breakfasts, unopened cans of most of these items were found in the cafeteria’s kitchen.

Next

Choose 3 correct answers and click next, use clues to move to next round

QUESTION 1/3

Test the home-preserved ginger and the unopened cans of breakfast.

Test those that became ill for infectious diseases

How would you proceed with your investigation to determine the vehicle of transmission?

Test all the breakfast ingredients

Commercial products should be tested as you do not want to miss a contaminated commercial product which could affect a large number of consumers

the base

$CODE$

CORRECT

1. pass: 34912
2. gap: 45

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Initial testing of the acidity and salinity of the single home-made product, preserved ginger, showed that it was an unlikely vehicle for transmission of botulism. The preserved ginger and remaining cans of items served at the implicated breakfasts wera then sent to the laboratory for bacteriologic and biologic testing. Serum specimens were also obtained from some of the surviving patients, though the specimens ware gathered 2-3 weeks aftar onaet of illness. At the end of the third week in October, an unopened jar of preserved peanuts produced by factory X was positive for type A botuiinal toxin. Serum specimens for all tested patients were negative. Some public health officials though a product recall should be initiated at this point.

Next

In considering a product racaLl!, who should be informed of the product recall and why?

Public

To prevent them from consuming the product

So then can withdraw the produce from their shelves

Store keepers

The responsible company

Distributors

Medical community

So they can stop distribution and notify the storekeepers who have received their shipments

Public health officials

So that the index of suspicion for cases of botulism is raised

(1) Because they need to know the correct information to disseminate 2) The watch for sgread of the outbreak to othar areas

Other governmental agencies involved in food regulation

1) To review their records to help to determine the place and timp of the product distribution 2) Identify how problem occurred

May have additional authority, staff and mechanisms to involved in food regulation conduct recall political good will

QUESTION 1/4 What information would you include in the recall message for each target group

Public

Product name, lot number if available, possible symptoms and signs that might occur, warnings to seek medical care if symptoms develop and where to return unused product

Private

Governmental

QUESTION 2/4 What information would you include in the recall message for each target group

Private

Product name, lot number, manufacturer, what to do with unused product

Store keepers & distributors

Public health officials

QUESTION 3/4 What information would you include in the recall message for each target group

Medical community

Product name, manufacturer, dates of distribution, person, time, and place of cases, disease of interest, case definitions, reporting of cases, how to collect specimens and where to send specimens for testing, referral and treatment recommendations

Public health officials

distributors

QUESTION 4/4 What information would you include in the recall message for each target group

Public health officials

Same as medical community

Private

distributors

the base

A product recall was implemented. Information concerning the recall was frequently broadcast by radio and television over several days and people were advised to return any Factory X peanuts to the nearest government health facility. Two more cases of botulism occurred in Cha+B Hwa County in late November. A 68 year-old woman and her 6 year-old grandson developed symptoms of botulism within 24 hours of eating peanuts that had been produced by Factory X on 10 September, the same day as the can implicated in the printing factory outbreak. The woman died at home on November 29, and the grandson was hospitalized with severe respiratory depression on November 30. A serum specimen collected shortly after admission was positive J'or type A botulinal toxin. The boy was placed on mechanical ventilation and treated with antitoxin provided by the Department of Health. He required prolonged assisted ventilation, but recovered completely.

Next

Choose 3 correct answers and click next, use clues to move to next round

QUESTION 1/3

Consumers not believing the recall and the seriousness

Ineffective communication to the public and merchants

What are the possible reasons for additional cases despite the aggressive recall

Recall was efficient and effective in their marketing about product

Merchants ignoring the recall

$CODE$

CORRECT

1. pass: 52104
2. gap: 45

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CONGRATULATIONS

You have completed the escape room, please screen shot or take picture to upload to dropbox

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CLUE1: 34

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CLUE2: 9

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ROOM 1

YOU JUST TO THE FIRST ROOM AND THERE'S PATIENTS EVERWHERE. LOOK AROUND THE ROOM AND FIGURE OUT THE FRST THNGS YOU HAVE TO DO AS SOON AS YOU GET TO THE FACTORY SITE AS A MEDICAL PRACTITIONER.

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CLUE

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TAKE A SCREENSHOT OF THIS PAGE ONCE YOURE DONE AND SEND THE ANSWER TO THE LINK BELOW

Use the pen icon to write your answers, then take a screenshot and send your answer to the link below DIvide the table into, the ILL, not ill and the breakfast in cafeteria ans the breakfast not in cafeteria then add the total and including the percentage

wrong answer

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TRY AGAIN

CORRECT

CLUE 2: 21

CORRECT

CLUE 1: 5

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CLUE3: 12

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CLUE 3: 04