48 Hours in Chaos: A Cyberattack on a Large Inpatient Hospital

Olivia Patel, Charge Nurse – ICU: A Nightmare Begins

The hospital was already buzzing with the early morning shift change when Nurse Olivia Patel logged into the EMR system—except this time, nothing happened. The loading screen froze, then flickered, then went black.

A new message appeared:

“Your files have been encrypted. Pay $10 million in Bitcoin to regain access.”

Her stomach dropped. The EMR was locked, medication orders were inaccessible, and the entire ICU was flying blind. She scanned the room—ventilated patients, post-op recoveries, a trauma transfer from the ER. A nurse rushed to her side, panic in her voice. “Olivia, I can’t log in. The medication cabinet isn’t working.”

Without electronic records, there was no way to check medication schedules or verify dosages. A chill ran down Olivia’s spine. This was more than an IT glitch. This was a full-scale attack.

She hurried to the nurse’s station and pulled out the thick binder of downtime procedures—only to find conflicting forms, outdated instructions, and different processes for each department.

Some were designed for short outages, others hadn’t been updated in years. A younger nurse flipped through pages with a confused expression. “Which one do we use?” she asked.

“We make it work,” Olivia said, ripping out the most recent medication tracking forms and improvising as best she could. They had no choice.

Losing Control

Mark Davis’s phone wouldn’t stop buzzing. By the time he answered the fourth call, he had the confirmation he dreaded: “It’s ransomware. The entire network is compromised.”

He ran to the command center, flipping through the Cyber Response Plan binder, scanning for immediate steps. IT was already isolating infected servers, but it wasn’t clear how far the damage had spread. “Do we have backups?” he asked.

“We don’t know yet,” the IT director admitted.

Mark took a breath and made the call: activate the Hospital Incident Command System (HICS). This wasn’t just a tech problem anymore—this was a full-blown hospital emergency.

By the time his emergency team assembled, it was clear that normal hospital operations couldn’t continue at full capacity. With no access to lab or imaging, no ability to process patient admissions, and no clear system for tracking administered medications, services had to be curtailed. He looked at the CEO, his voice firm. “We need to shut down non-critical services. Outpatient procedures, elective surgeries, anything that isn’t life-saving—it has to go.”

A Hospital in Freefall

Emma Caldwell had barely had time to process the words before she was in her car, speeding toward the hospital. “We’re under attack.”

By the time she arrived, chaos was already setting in. The phone system was down, the patient portal unresponsive, and a growing line of frustrated clinicians formed outside the IT office.

She made her way to the command center, trying to piece together a response for the CEO.

“How bad is it?” she asked.

“No EMR, no scheduling, no radiology, no lab access,” Mark said, rubbing his forehead. “We have to assume no one has access to patient data.”

Emma exhaled. Hundreds of patients. No digital records. No reliable way to coordinate care.

This was a nightmare. Then came the next crisis.

Departments were pulling out their individual downtime forms—none of them aligned. The pharmacy had one set of procedures, radiology had another, and the ICU was improvising a third.

There was no single system guiding the hospital. Mark and Emma looked at each other. “We need to standardize this. Now.”

Improvising to Survive

With the EMR down, Olivia made a decision: go manual. She pulled out the downtime binder and handed out stacks of paper downtime forms.

“Write down everything,” she told the nurses. “Every dose, every change, every patient update.”

Then came the next big problem—medications. The automated dispensing cabinets required badge scanning login, now frozen.

A pharmacy tech arrived with a locked cart of essential meds, but tracking doses without a digital system was a logistical nightmare. “Go old school,” Olivia said, grabbing a whiteboard.

“We track every single patient med right here. No mistakes.”

Fighting an Invisible Enemy

Mark walked the halls, assessing failures across the hospital. IV pumps, and heart monitors were still operational, but radiology was completely down, meaning only manual X-rays were possible.

The blood bank had no access to its inventory logs. The Emergency Department was overflowing with trauma patients, but without electronic patient histories, every intake was a guessing game.

Then, another wave of bad news hit—the hospital’s VoIP phone system was down. Nurses couldn’t page doctors. Departments couldn’t reach each other. “We’ll go to two-way radios and runners,” he announced.

Back to basics.

Making the Hardest Decisions

Emma was now deep into service curtailment decisions. Non-emergency surgeries were canceled. Elective outpatient services were suspended. Incoming patient volume was being diverted to nearby hospitals if patients were stable.

Even as she made the calls, she knew the damage was already being done. Patients were going to be angry. Some would demand transfers. Others would panic.

The hospital couldn’t keep functioning at full tilt—not without clear, unified downtime procedures guiding them. She made a mental note: This cannot happen again.