SOP for the 'Ransomware' Scenario in Medical/Healthcare Environments

Scenario:'Ransomware' Scenario in Hospitals!

Here's a highly detailed Standard Operating Procedure (SOP) for a Ransomware Incident in a Hospital that a real security team could use.

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1. Purpose: To establish a structured response plan for detecting, containing, mitigating, and recovering from a ransomware attack on hospital IT and OT systems while ensuring minimal disruption to patient care.

2. Scope: Applies to all hospital networks, IT infrastructure, medical devices, administrative systems, and personnel involved in cybersecurity and incident response.

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3. Incident Response Phases

Phase 1: Detection & Initial Response (0-15 Minutes)

• 3.1. Identify ransomware symptoms (file encryption, ransom note, system lockout): IT Staff, SOC Analysts
• 3.2. Verify ransomware presence via endpoint detection & response (EDR), SIEM logs, or anomaly detection: Security Operations Center (SOC)
• 3.3. Immediately isolate affected endpoints from the hospital network (physically disconnect, disable network adapters): IT Staff
• 3.4. Activate the Incident Response Team (IRT) and notify hospital leadership: IT Security Manager
• 3.5. Disable VPNs and remote access to prevent further spread: Network Admin

Phase 2: Containment (15-30 Minutes)

• 3.6. Identify affected servers, workstations, and medical devices: SOC Analysts
• 3.7. Disable compromised user accounts and revoke admin credentials if suspected of compromise: IT Security Team
• 3.8. Activate network segmentation policies to contain the ransomware: Network Admin
• 3.9. Collect and preserve forensic evidence (logs, memory dumps, affected files): Digital Forensics Team
• 3.10. Inform relevant authorities (CISA, HHS, FBI, local cybersecurity agencies): Compliance Officer

Phase 3: Eradication & Investigation (30-120 Minutes)

• 3.11. Run security tools (EDR, AV, forensic tools) to identify root cause and affected areas: SOC Team
• 3.12. Review SIEM logs, firewall traffic, and anomaly detection alerts: Incident Response Team
• 3.13. Ensure no further infections are spreading before restoring systems: IT Security Team
• 3.14. Identify and close security gaps (unpatched vulnerabilities, weak passwords, exposed RDP): Vulnerability Management Team
• 3.15. Determine attack vector (phishing, exploit, unpatched system): Threat Intelligence Team

Phase 4: Recovery (2-12 Hours)

• 3.16. Restore systems from backups, ensuring backups are clean:  IT Recovery Team
• 3.17. Change all admin credentials and implement MFA: IT Security Team
• 3.18. Test critical hospital services (EHR, patient monitoring, lab systems) for functionality: Medical IT Staff
• 3.19. Conduct a post-recovery assessment with hospital leadership: IT Director

Phase 5: Lessons Learned & Hardening (24-48 Hours)

• 3.20. Conduct a forensic analysis of the attack and document findings: Forensic Team
• 3.21. Implement additional security controls (network segmentation, patching, phishing training): CISO & IT Security
• 3.22. Conduct a post-incident review meeting to improve the response process: Hospital Leadership

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4. Communication Plan

Audience	Communication Channel	Responsibility
IT & Security Teams	Internal SOC Dashboard, Email	IT Security Manager
Hospital Staff	Email, Emergency Alerts	Compliance Officer
External Agencies (FBI, CISA, HHS)	Secure Communication	Compliance Officer
Patients & Public (if necessary)	Press Release, Website	Public Relations

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5. Prevention & Mitigation Strategies

1. Medical Asset Management: Periodic management of various types of medical devices and equipment
2. Medical Vulnerability/Threat Monitoring: Periodic vulnerability and continuous threat monitoring of devices and networks
3. Regular Backup Strategy: Ensure immutable backups and test restoration regularly.
4. Network Segmentation: Isolate critical hospital OT and IT systems from administrative networks.
5. Access Control: Enforce least privilege access and implement MFA on all accounts.
6. Email Security: Train staff to recognize phishing emails and implement email filtering.
7. Patch Management: Regularly update software and apply security patches.
8. Incident Drills: Conduct ransomware attack simulation exercises at least twice a year.

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6. Escalation Matrix (Severity Level)

• (Low) Single workstation affected: SOC Analyst → IT Manager
• (Medium) Multiple systems impacted, but no critical hospital operations affected: IT Security → Incident Response Team
• (High) Critical hospital services impacted (EHR, ICU systems, lab equipment): CISO → Hospital CEO

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7. Compliance & Legal Considerations

• HIPAA: Ensure patient data protection measures are in place.
• NIST CSF: Align response with cybersecurity framework best practices.
• FDA Cyber Guidelines: If medical devices are affected, report to regulatory bodies.

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Recap

This playbook also ensures a structured and rapid response to a ransomware attack in a hospital while minimizing patient care disruptions. This SOP should be reviewed and updated quarterly or after any real-world incident to incorporate lessons learned.

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