7 Impact of a Hospital Cyberattack on EMS Arrivals at Neighboring Emergency Departments

Abstract

Cyber attacks, including ransomware on health care delivery organizations (HDO), are increasing in severity and frequency. Emergency medical services (EMS) plays a significant role in emergency care and disaster response, including the rapid transport of acute patients to receiving emergency departments (EDs). EMS ambulance diversion from one facility to another is a common occurrence with ED crowding, but it can be a result of internal or external disasters as well. The effects of health care cyber attacks on EMS transports and census has yet to be reported in the literature. The purpose of this study is to report regional EMS census impacts during an active cyber-attack on a neighboring HDO. We performed a retrospective analysis of the daily combined EMS transport census of two large urban academic EDs in San Diego, CA during the first week of a ransomware cyber-attack on a nearby multi-hospital HDO (May 2nd - 8th 2021). We then compared the mean to the previous 4 weeks. A one-way analysis of variance (ANOVA) and Tukey test were used to compare EMS transport numbers by week. The mean combined daily EMS census for weeks 1 - 4 (no cyber-attack) were: week 1 (April 4th – 10th) – 69 (SD 10), week 2 (April 11th – 17th) – 68 (SD 5), week 3 (April 18th – 24th) – 71 (SD 7), and week 4 (April 25th – May 1st) – 75 (SD 9). For week 5 (week of the cyber-attack) the mean was 116 (SD 24). There was a statistically significant higher EMS census during the cyber-attack when compared to the 4 weeks prior (Table 1), with most days experiencing double the normal volume (Range 78 -144). This study reports a significant increase in EMS ambulance arrivals at two EDs in proximity to a multi-hospital HDO under active cyber-attack. This result suggests cyber-attacks can have significant regional impacts on EMS volumes, and therefore, cyber disaster planning should take into consideration potentially large diversions of patients to other facilities via EMS.