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Cyber-resilient intensive care unit: ransomware is a patient-safety crisis—a resource-stratified approach for India
Choudhuri, Bodhisatwa Prakash, Jay Pal, Biplab
Choudhuri, Bodhisatwa
Prakash, Jay
Pal, Biplab
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2026-05-25
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Abstract
Ransomware and cyber incidents targeting hospital digital infrastructure have emerged as genuine patient-safety threats yet remain under-recognized in critical care practice. Intensive care units (ICUs) are uniquely vulnerable: Physiological states are tightly coupled to digital workflows, electronic health records (EHRs) anchor medication safety, and dense Internet of Medical Things (IoMT) environments expand the attack surface. India faces a compounded risk—the 2022 All India Institute of Medical Sciences (AllIMS) Delhi ransomware attack exposed fragmented systems, an absence of post-incident clinical surveillance, and the operational reality that "Western" cybersecurity fixes do not translate directly to resource-variable settings. This Viewpoint reframes cyber-resilience as a bedside safety competency rather than an information technology (IT) concern and proposes a resource-stratified three-tier preparedness framework. Tier 1 defines minimum viable controls achievable by any ICU: Downtime kits, paper medication administration records (MARs), designated roles, and structured drills. Tier 2 adds targeted redundancy; tier 3 outlines advanced capabilities for tertiary centers. When digital systems fail, patient survival depends on analog competencies practiced before the crisis.
Citation
Choudhuri, B., Prakash, J., Pal, B., Veenith, T. (2026) Cyber-resilient intensive care unit: ransomware is a patient-safety crisis—a resource-stratified approach for India. Indian Journal of Critical Care Medicine, 30(5), pp. 363-367.
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Journal article
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en
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© 2026 The Authors. Published by Jaypee Brothers Medical Publishing. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.5005/jp-journals-10071-25203
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ISSN
0972-5229
EISSN
1998-359X