Memorial Health System: Regional Hospital During Peak Flu Season

Organization Profile

  • Type: Regional acute care hospital and Level II trauma center
  • Size: 400-bed facility, 1,800 employees (450 physicians, 800 nurses, 550 support staff)
  • Operations: Emergency services, intensive care, surgical services, inpatient care, outpatient clinics
  • Critical Services: 24/7 emergency department (65,000 annual visits), intensive care unit (45 beds), surgical suites (12 operating rooms), patient monitoring systems
  • Technology: Integrated EHR system (Electronic Health Records), medical device networks, patient monitoring systems, laboratory information systems, pharmacy systems, administrative networks

Memorial Health System serves a population of 500,000 across a three-county region. The hospital is the only Level II trauma center within 60 miles, making it the critical care destination for serious medical emergencies. Current status: Flu season surge with ED at 150% capacity, ICU completely full, surgical teams working extended schedules.

Key Assets & Impact

What’s At Risk:

  • Patient Life Safety: ED has 35 patients awaiting treatment, ICU monitors 45 critical patients, 3 surgeries currently in progress—any system failure during surge conditions directly threatens lives
  • Critical Care Operations: EHR system contains allergy information, medication orders, lab results, imaging for 400 current inpatients—clinicians making life-saving decisions without access risk deadly medical errors
  • Emergency Services Continuity: Hospital is sole Level II trauma center for region—prolonged system downtime forces ambulance diversion to facilities 60+ miles away, increasing patient mortality during “golden hour”

Immediate Business Pressure

Tuesday evening, peak flu season. Memorial activated surge protocols 6 hours ago. Emergency department treating 35 patients with 12-hour wait times. ICU at full capacity with ventilator-dependent patients. Three surgical teams in active procedures. Hospital just accepted two Level II trauma cases via ambulance when systems began failing.

Dr. Patricia Lee (ED Director) has patients requiring immediate treatment decisions—one with suspected allergic reaction needs medication, but EHR is inaccessible. She cannot verify patient allergies, previous medications, or current conditions. Lab results for 8 patients in ED are trapped in failing systems. Every minute of system downtime increases risk of medical errors that could be fatal.

Critical Timeline:

  • Current moment (Tuesday 7pm): Systems failing in real-time, 3 surgeries in progress, ED at crisis capacity
  • Stakes: Patient lives directly at risk—wrong medication due to missing allergy data could be fatal, surgical teams losing access to imaging mid-procedure
  • Dependencies: 35 ED patients awaiting care, 45 ICU patients on continuous monitoring, regional EMS system routing all trauma cases to Memorial, no alternative Level II trauma center within reasonable transport time

Cultural & Organizational Factors

Why This Vulnerability Exists:

  • Patient-centered mission above all else: Hospital culture prioritizes “patient care first”—when IT proposed taking medical device networks offline for security patches, clinical leadership refused due to potential care disruption. Security updates repeatedly delayed for “when it’s less busy” (which never comes during flu season).
  • FDA medical device regulations create patch paralysis: Legacy medical equipment (ventilators, patient monitors, infusion pumps) runs on certified Windows systems—applying patches voids FDA certification and manufacturer warranties. IT cannot patch these systems without months-long recertification process. Result: Known vulnerabilities remain unpatched.
  • Operational convenience over network segmentation: Clinical staff demanded seamless connectivity between administrative workstations and medical device networks for “workflow efficiency.” Network segmentation proposals rejected as “too restrictive” and “impacting patient care.” Single compromised administrative workstation now threatens entire clinical network.
  • Resource constraints during perpetual crisis: Hospital operates under constant surge conditions (flu season, opioid crisis, trauma). No “good time” exists for security maintenance. IT security team consists of 3 people managing 1,800 employee devices plus hundreds of medical devices. Security becomes “when we have time” (never).

Operational Context

How This Hospital Actually Works:

Memorial Health operates in permanent crisis mode—flu season means every bed full, every clinician overworked, every system pushed to capacity. IT security proposed segmented networks and updated patches for 18 months. Clinical leadership approved plans but postponed implementation “until after flu season” (which runs October through March). When not in flu season, there’s summer trauma surge. Network architecture reflects years of “yes to security, no to disruption”—approved in principle, never executed in practice. The gap between written policy (patch within 30 days) and reality (medical device networks unpatched for 3+ years) created the perfect conditions for WannaCry.

Key Stakeholders (For IM Facilitation)

  • Dr. Susan Williams (Chief Medical Officer) - Managing patient surge and clinical response, must balance security containment with life-saving operations
  • Dr. Patricia Lee (Emergency Department Director) - 35 patients in ED awaiting treatment, demanding immediate system access for patient safety
  • Thomas Anderson (IT Director) - Watching systems fail in real-time, trying to contain worm while protecting life-critical medical devices
  • Brian Martinez (Network Administrator) - Discovering scope of unpatched systems as attack spreads, realizes delayed updates created vulnerability

Why This Matters

You’re not just responding to a ransomware attack—you’re protecting patient lives during a medical surge crisis where every minute of system downtime increases the risk of deadly medical errors. A physician cannot verify patient allergies before administering medication. Surgical teams are losing access to imaging during active procedures. ICU monitoring systems are at risk. The hospital is the only Level II trauma center for 500,000 people—there’s nowhere else to send patients. Your incident response decisions directly impact whether patients live or die tonight.

IM Facilitation Notes

  • This is about life safety first, cybersecurity second: Frame every decision around “what keeps patients alive right now.” Players often focus purely on technical containment—remind them ED has 35 patients, 3 surgeries in progress, ICU monitoring 45 critical patients.
  • The FDA medical device patch problem is real: Don’t let players dismiss “just patch everything” as easy solution. Medical devices with FDA certification cannot be patched without losing certification and warranty. This is authentic healthcare cybersecurity complexity.
  • Operational convenience created the vulnerability: Players will blame IT incompetence—correct this. Clinical leadership blocked segmentation because doctors demanded workflow efficiency. This is organizational culture failure, not IT failure.
  • Time pressure is crushing: Hospital is at 150% capacity during surge. There is no “shut everything down safely” option. Life-critical systems cannot be taken offline without moving patients (impossible during surge). Force players to make hard choices with incomplete information under time pressure.
  • Regional critical infrastructure dependency: Memorial is the only Level II trauma center within 60 miles. System downtime doesn’t just affect current patients—it affects entire regional EMS system. Ambulance diversion means trauma patients die in transport.