Open Access

Today’s medical IT is more and more connected and network or IT system outages may impact the quality of patient treatment. IT outages from cyberattacks are particularly worrisome if attackers focus on those medical IT devices that are critical for medical processes. However, medical processes are primarily documented for the hospital employees and not for analyzing the criticality of any given human or medical IT resource. This paper presents a generic model for realistic, patient-focused simulation of medical processes. The model allows the simulation of cyber incidents, focusing on device outages or overload situations like mass casualty incidents. Furthermore, we present a proof-of-concept tool that implements the described model, enabling end-users to simulate their processes. The tool offers the ability to run with low detailed data for overview purposes and highly detailed data for fine-grained simulation results. We perform different scenario simulations for a sample hospital, including the acute phase of a ransomware attack, negative performance impacts due to the implementation of cybersecurity measures, and emergency plans for mass casualty incidents. In each scenario, the respective simulation resulted in a quantitative statement of how these scenarios affect overall process performance and show possible key factors supporting decision-making. We use real-world data from a German trauma room to optimize and evaluate the process simulation.

S/MIME and OpenPGP use cryptographic constructions repeatedly shown to be vulnerable to format oracle attacks in protocols like TLS, SSH, or IKE. However, format oracle attacks in the End-to-End Encryption (E2EE) email setting are considered impractical as victims would need to open many attacker-modified emails and communicate the decryption result to the attacker. But is this really the case? In this paper, we survey how an attacker may remotely learn the decryption state in email E2EE. We analyze the interplay of MIME and IMAP and describe side-channels emerging from network patterns that leak the decryption status in Mail User Agents (MUAs). Concretely, we introduce specific MIME trees that produce decryption-dependent network patterns when opened in a victim’s email client. We survey 19 OpenPGP- and S/MIME-enabled email clients and four cryptographic libraries and uncover a side-channel leaking the decryption status of S/MIME messages in one client. Further, we discuss why the exploitation in the other clients is impractical and show that it is due to missing feature support and implementation quirks. These unintended defenses create an unfortunate conflict between usability and security. We present more rigid countermeasures for MUA developers and the standards to prevent exploitation.

OpenPGP is one of the two major standards for end-to-end email security. Several studies showed that serious usability issues exist with tools implementing this standard. However, a widespread assumption is that expert users can handle these tools and detect signature spoofing attacks. We present a user study investigating expert users' strategies to detect signature spoofing attacks in Thunderbird. We observed 25 expert users while they classified eight emails as either having a legitimate signature or not. Studying expert users explicitly gives us an upper bound of attack detection rates of all users dealing with PGP signatures. 52% of participants fell for at least one out of four signature spoofing attacks. Overall, participants did not have an established strategy for evaluating email signature legitimacy. We observed our participants apply 23 different types of checks when inspecting signed emails, but only 8 of these checks tended to be useful in identifying the spoofed or invalid signatures. In performing their checks, participants were frequently startled, confused, or annoyed with the user interface, which they found supported them little. All these results paint a clear picture: Even expert users struggle to verify email signatures, usability issues in email security are not limited to novice users, and developers may need proper guidance on implementing email signature GUIs correctly.

Technical and organizational steps are necessary to mitigate cyber threats and reduce risks. Human behavior is the last line of defense for many hospitals and is considered as equally important as technical security. Medical staff must be properly trained to perform such procedures. This paper presents the first qualitative, interdisciplinary research on how members of an intermediate care unit react to a cyberattack against their patient monitoring equipment. We conducted a simulation in a hospital training environment with 20 intensive care nurses. By the end of the experiment, 12 of the 20 participants realized the monitors’ incorrect behavior. We present a qualitative behavior analysis of high performing participants (HPP) and low performing participants (LPP). The HPP showed fewer signs of stress, were easier on their colleagues, and used analog systems more often than the LPP. With 40% of our participants not recognizing the attack, we see room for improvements through the use of proper tools and provision of adequate training to prepare staff for potential attacks in the future.

Due to the increasing connectivity of modern vehicles, collected data is no longer only stored in the vehicle itself but also transmitted to car manufacturers and vehicle assistant apps. This development opens up new possibilities for digital forensics in criminal investigations involving modern vehicles. This paper deals with the digital forensic analysis of vehicle assistant apps of eight car manufacturers. We reconstruct the driver’s activities based on the data stored on the smartphones and in the manufacturer’s backend. For this purpose, data of the Android and iOS apps of the car manufacturers Audi, BMW, Ford, Mercedes, Opel, Seat, Tesla, and Volkswagen were extracted from the smartphone and examined using digital forensic methods following forensics guidelines. Additionally, manufacturer data was retrieved using Subject Access Requests. Using the extensive data gathered, we reconstruct trips and refueling processes, determine parking positions and duration, and track the locking and unlocking of the vehicle. Our findings show that the digital forensic investigation of smartphone applications is a useful addition to vehicle forensics and should therefore be taken into account in the strategic preparation of future digital forensic investigations.