Overmedicated: Breaking the Security Barrier of a Globally Deployed Infusion Pump

Cyberattacks on medical centers are one of the most despicable forms of cyber threat there is. For instance, on October 28th, 2020, a cyberattack at the University of Vermont Medical Center in Burlington VT led to 75% of the scheduled chemotherapy patients being turned away. Many of us have friends and loved ones who have had to undergo intensive treatments, and the last thing we want in this situation is for their critical care to be delayed due to on-going cyberattacks. Yet, as concerning as ransom attacks can be, what if the process of receiving the treatment was an even bigger threat than a system-wide ransomware event?

McAfee’s Enterprise Advanced Threat Research team, in partnership with Culinda, have discovered a set of vulnerabilities in B. Braun Infusomat Space Large Volume Pump and the B. Braun SpaceStation.

McAfee Enterprise ATR remotely hacks a B.Braun Infusomat Pump

These critical vulnerabilities could allow an attacker to conduct remote network attacks and modify the amount of medication a patient will receive through infusion. This modification could appear as a device malfunction and be noticed only after a substantial amount of drug has been dispensed to a patient, since the infusion pump displays exactly what was prescribed, all while dispensing potentially lethal doses of medication. This attack scenario is made possible through a chain of known and previously unknown vulnerabilities found by McAfee Enterprise ATR. A critical component of this attack is that the pump’s operating system does not verify who is sending commands or data to it, allowing an attacker to carry out remote attacks undetected. For those looking for a more technical analysis of the vulnerabilities, an in-depth blog can be found here.

History and Industry Insights

From the 1960’s to 2000, infusion pumps were mostly electromechanical devices with an embedded operating system, but the turn of the century delivered “smarter” devices with better safety mechanisms and the possibility to program them, which slowly opened the door to computer security challenges. Today, it is estimated that there are over 200 million IV infusions administered globally each year. The infusion pump market is a clear potential target for attackers. The market is valued at an estimated $54 billion in annual revenue, with 2020 sales of IV pumps in the US at $13.5 billion. IV pumps are inherently trusted to be secure and have over time become the mainstay for efficient and accurate infusion delivery of medication. B. Braun is one of the key market share holders in this rapidly growing market, emphasizing the impact of these vulnerability discoveries.

Industry personnel can be the best source of information for determining impact. Shaun Nordeck, M.D, an Interventional Radiology Resident Physician at a Level 1 Trauma Center, prior Army Medic and Allied Health Professional, with more than 20 years in the medical field, states that: “Major vulnerability findings like the ones reported by McAfee’s Enterprise Advanced Threat Research team are concerning for security and safety minded medical staff. The ability to remotely manipulate medical equipment undetected, with potential for patient harm, is effectively weaponizing these point of care devices. This is a scenario previously only plausible in Hollywood, yet now confirmed to be a real attack vector on a critical piece of equipment we use daily. The ransomware attacks that have targeted our industry rely on vulnerabilities just like these; and is exactly why this research is critical to understanding and thwarting attacks proactively.”

These vulnerabilities were reported to B. Braun beginning in January 2021 through McAfee’s responsible disclosure program. Through ongoing dialog, McAfee Enterprise ATR have learned that the latest version of the pump removes the initial network vector of the attack chain. Despite this, an attacker would simply need another network-based vulnerability and all remaining techniques and vulnerabilities reported could be used to compromise the pumps. Additionally, the vulnerable versions of software are still widely deployed across medical facilities and remain at risk of exploitation. Until a comprehensive suite of patches is produced and effectively adopted by B. Braun customers, we recommend medical facilities actively monitor these threats with special attention, and follow the mitigations and compensating controls provided by B. Braun Medical Inc. in their coordinated vulnerability disclosure documentation.

Call to Action

This concludes a research project which took two senior researchers a significant amount of time to showcase a life-threatening risk of a medical device being taken over by a remote attacker. For the time being, ransomware attacks are a more likely threat in the medical sector, but eventually these networks will be hardened against this type of attack and malicious actors will look for other lower-hanging fruits.

The unfortunate reality is that individuals can’t do much to prevent or mitigate these enterprise-level risks, outside of staying mindful of security issues and maintaining awareness of possible threats. However, the good news is that security researchers continue to propel this industry towards a safer future through responsible disclosure. We strongly encourage vendors to embrace vulnerability research and consumers to demand it. The medical industry has lagged severely behind others in the realm of security for many years – it’s time throw away the digital “band-aids” of slow and reactive patching, and embrace a holistic “cure” through a security-first mindset from the early stages of development, combined with a rapid and effective patch solution.

Braun Medical Inc. Statement

In May 2021, B. Braun Medical Inc. disclosed information to customers and the Health Information Sharing & Analysis Center (H-ISAC) that addressed the potential vulnerabilities raised in McAfee’s report, which were tied to a small number of devices utilizing older versions of B. Braun software. Our disclosure included clear mitigation steps for impacted customers, including the instructions necessary to receive the patch to eliminate material vulnerabilities.

Braun has not received any reports of exploitation or incidents associated with these vulnerabilities in a customer environment.