In the digital age, hospitals are not only centers of healthcare but also hubs of vast data and technology-dependent operations.

The threat of ransomware—malicious software that encrypts files and demands a ransom for their release—poses a significant risk to the continuity of critical healthcare services. As a hospital crisis manager, I’ve seen firsthand the devastation a cyber-attack can bring to an unprepared institution. This blog aims to underscore the importance of ransomware preparedness and the effectiveness of tabletop exercises in equipping hospital staff to handle such crises. 

Preventing Ransomware Attacks in Hospitals 

The best defense against ransomware is a proactive offense. Hospitals must implement comprehensive cybersecurity measures to thwart attacks before they occur. Measures include: 

  • Conducting regular staff training to recognize phishing attempts. 
  • Ensuring that all software and systems are up-to-date with the latest security patches. 
  • Maintaining secure and isolated backups of all critical data. 

In my experience, a hospital that prioritizes these preventive measures significantly reduces its vulnerability to ransomware attacks. 

A Real-World Ransomware Attack Example 

I remember a day that started like any other but quickly became a nightmare. A sophisticated ransomware attack hit a neighboring hospital that paralyzed its entire network. Patient records were inaccessible, critical equipment was rendered inoperative, and the hospital’s operations stopped. The attack was not just an inconvenience; it was a matter of life and death. This incident was a stark reminder of the real-world consequences of cyber threats and the need for constant vigilance. 

Developing Your Ransomware Tabletop Exercise 

Creating a ransomware tabletop exercise requires careful planning and a deep understanding of the hospital’s vulnerabilities and response capabilities. The exercise should begin with clear objectives: What do you want to achieve? Which systems and processes are you testing? From there, develop challenging and realistic scenarios based on potential threats the hospital may face. The goal is to create a learning environment that tests the hospital’s incident response plan and improves the staff’s readiness to respond to an actual ransomware attack. 

Related: Ransomware Tabletop Exercises: Strengthen Your Crisis Management Team

Components of a Tabletop Exercise 

A successful tabletop exercise is composed of several vital components. The scenario brief sets the stage, providing participants with the context of the simulated attack. Roles and responsibilities must be clearly defined, ensuring each participant understands their part in the exercise. Effective communication protocols are crucial, as they will be under real-world stress during an attack. Finally, debrief sessions are essential for discussing what went well, what didn’t, and how the response plan can be improved. 

Validating the Incident Response Plan 

The tabletop exercise is critical for validating the hospital’s incident response plan. It identifies gaps in the plan and provides a safe space to test and refine the hospital’s response strategies. Through these exercises, staff can become familiar with their roles and the actions they must take during an actual ransomware attack, ensuring a coordinated and efficient response. 

Resource: Principles of Simulation Exercises – Online Training


Ransomware attacks are not a question of if but when. Hospitals must be prepared to respond swiftly and effectively to protect patient safety and maintain operational continuity. Tabletop exercises are vital in this preparedness, allowing hospitals to test and refine their incident response plans. As a hospital crisis manager, I cannot stress enough the importance of these exercises in building a resilient defense against the ever-present ransomware threat. 

Rob Burton
Rob Burton

Rob is a Principal at PreparedEx where he manages a team of crisis preparedness professionals and has over 20 years of experience preparing for and responding to crises. Part of his leadership role includes assisting PreparedEx clients in designing, implementing and evaluating crisis, emergency, security and business continuity management programs. During his career Rob has worked for the US State Department’s Anti-Terrorism Assistance Program, as a crisis management consultant in Pakistan and Afghanistan where he negotiated with the UN and Pashtun tribal warlords and he served with the United Kingdom Special Forces where he operated internationally under hazardous covert and confidential conditions. Rob was also part of a disciplined and prestigious unit The Grenadier Guards where he served Her Majesty Queen Elizabeth II at the Royal Palaces in London. Rob was a highly trained and experienced infantryman serving in Desert Storm and commanded covert operational teams and was a sniper. Rob has keynoted disaster recovery conferences and participated in live debates on FOX News regarding complex security requirements and terrorism. Rob has a Queen’s Commendation for Bravery.