Numb lips at 21:40
A 12-guest banquet at a licensed fugu restaurant. The in-house handler processed the fish that morning and the 薄造り is sliced about 3 mm thick. Plates are arranged at 17:30 and held on a stainless bench in a 24 °C room until service at 19:00; a second batch of sashimi comes from a supplier's vacuum-packed, pre-sliced product opened at 18:45. ふぐちり follows. At 21:40 three guests report tingling of the lips and tongue; one cannot walk steadily and says his hands feel numb; another has vomited twice. An ambulance is called at 21:47. Eight vacuum packs from the same supplier lot were sold to takeaway customers that afternoon. The kitchen still holds fish frames, the 出汁 pot, the knives and the empty supplier packs, but a server has already carried the leftover sashimi to the back and scraped it into the bin.
1. Set out your actions in the first hour, in order.
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Care of the guests comes first and is already moving: ambulance at 21:47 is correct. Do not induce vomiting, do not give food or drink, keep the airway clear, and be ready to support breathing - tetrodotoxin produces ascending numbness and paralysis with respiratory failure, there is no antidote, and hospital care is supportive. Send a staff member with the patients who can state exactly what was eaten and when.
In parallel, stop all fugu service and freeze the scene: retrieve the scraped leftovers from the bin if they can still be identified, and hold the plates, the 出汁, the frames, the knives, the supplier packs with lot codes, and the preparation records. Cover and refrigerate them, labelled, rather than freezing, and let nobody eat the leftovers.
Notify the 保健所 immediately, then the supplier; compile the guest list with contact details; and write a chronology from delivery to plating while memories are fresh. Onset 60–120 minutes after the meal is consistent with tetrodotoxin.
2. Three of twelve guests are ill. How do you use traceability to find the source, and what do you do about the takeaway packs?
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Two products were served, so build a simple exposure table: for each guest, which sashimi they ate (in-house, supplier pack, or both) and whether they ate ちり, using the order slips and the server's memory. If the three who are ill are the only ones who ate the in-house product, that is your working hypothesis; if they are spread across both products, look instead for a shared item or a shared knife and board.
The processing record then narrows it: which fish, which lot, who processed, when, which organs came out, and whether any cross-contamination step occurred. The 3 mm slice and the 90-minute hold at 24 °C are quality problems, but they do not create tetrodotoxin - the toxin must come from the fish or from a contaminated tool, so do not let the holding time become the explanation by default.
The eight takeaway packs from the same supplier lot must be recalled now: telephone each buyer, tell them not to eat the product, to keep the pack and the label, and to seek care at once if they feel numbness. Ask the 保健所 to notify the supplier so other buyers in the lot are reached.
3. In the debrief, what changes to the HACCP-based plan would you insist on?
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Set the control points where the hazard actually is. Species and lot verification at receiving, with the licence holder signing acceptance. Licensed processing with toxic organs accounted for - organ count against fish count. Tool segregation, with dedicated colour-coded knives and boards and a written cleaning and disinfection step after any contact with liver, ovary, intestine or skin. Cold holding with a documented temperature and time limit for plated sashimi, replacing the 24 °C bench hold. Separation of in-house and supplier product so that a recall can be executed at lot level.
Then the verification side: a processing and disposal record kept for the period the ordinance requires, a named person responsible for a recall decision, contact details for every takeaway customer, and a written procedure for a suspected poisoning that begins with 119 and 保健所 and ends with preserved samples.
Finally, rehearse it once with staff, because the failure in this incident was not knowledge of the toxin - it was that nobody had decided in advance who stops the service and who secures the plates.