On April 26, 2025, the Governor Juan F. Luis Hospital and Medical Center (JFL) on St. Croix, U.S. Virgin Islands, faced a serious cyber security incident, but a swift, coordinated response ensured patient safety and operational continuity.

The HHS Administration for Strategic Preparedness and Response (ASPR) worked with the Department of Homeland Security (DHS), the Virgin Islands Department of Health (VIDOH) and the Virgin Islands Territorial Emergency Management Agency (VITEMA) to mobilize the resources needed to ensure continuity of patient care. One critical element of the response was ASPR’s Disaster Telemedicine capabilities. These capabilities were used to process over 250 radiology studies, including the backlogged cases.

Bridging the Gaps in Care

The cybersecurity breach significantly disrupted JFL’s IT infrastructure and limited access to essential clinical systems, including radiology services. Although the hospital maintained the ability to perform and interpret emergent imaging studies, their picture archiving and communication system, the system by which digital medical imaging can be transmitted and viewed, was offline. Switching from networked to non-networked digital and analog systems required significant additional resources and threatened to create a critical workflow bottleneck that could delay diagnoses, prolong treatment decisions, and overwhelm an already strained hospital.

At the request of local and federal partners, ASPR's Disaster Telemedicine team with two ASPR Region 2 Regional Emergency Coordinators (RECs), rapidly assessed the situation alongside local staff. Together, they devised a rapidly deployable solution to support ongoing hospital services and recovery efforts utilizing ASPR’s telemedicine resources. ASPR’s goal was to facilitate timely access to radiology images; support real-time and back-log radiologist interpretation and reporting on x-rays, ultrasounds, and CT scans; and provide rapid access to remote medical specialists to support emergency department flow.

ASPR’s Disaster Telemedicine team deployed and implemented two secure, tailored telemedicine systems, including our specialized communications and diagnostic equipment. Our rugged tablets with fail-over connectivity provided secure access to the ASPR Disaster Telemedicine videoconferencing and electronic medical record platform for communications and documentation. High-fidelity audio and visual equipment enabled high quality remote specialist patient evaluations and collaborations with JFL medical staff while our integrated ultrasound offered remote guidance and interpretation for emergent point-of-care ultrasound.

Through our telemedicine provider network, requested specialists, including radiology, neurology, and psychiatry, were available 24/7 to deliver timely and accessible remote consultations. Teleradiologists, from 5 states (California, Georgia, Nevada, Pennsylvania, and Texas), interpreted urgent and emergent imaging, engaging directly with JFL medical staff as needed, also providing final radiology reports for current and back-logged diagnostic images. These resources not only helped alleviate the immediate workload stress on an overburdened system but also enabled clinicians to make faster, better-informed decisions.

Making a Measurable Impact

ASPR’s Disaster Telemedicine support delivered several notable outcomes:

• Over 250 radiology studies reported, including backlogged cases, helping to clear a mounting diagnostic logjam.
• Within one hour, final radiology reports of emergency imaging reads with emergent findings were returned to medical staff.
• Secure access to imaging enabled physicians to review images from their laptops or tablets, without leaving their departments or patients or the need to interrupt radiology technician’s work to view images directly on CT or x-ray equipment.
• Teleradiologist support, including radiologists and a neuroradiologist for complex neurological imaging, helped JFL manage a wide range of patient needs during the outage.
• Teleneurologist support including six neurologist consults for emergency department patients. These consults supported clinical management decision making, diagnosis, and facilitated two critical transfers off-island for definitive care.
• Optimized use of limited hospital staff and IT resources, ensuring that on-island personnel could maintain timely and high-quality patient care, decrease barriers to patient flow, reduce stress on hospital resources, and aid in the recovery process.

These actions were not just stopgap measures, this crisis response also generated valuable baseline data that ASPR and JFL can use to guide future telemedicine integration for steady-state as well as disaster response.

A Model of Collaborative Response

“This collaboration was nothing short of extraordinary,” said Darlene Baptiste, Chief Executive Officer of JFL. “We extend our heartfelt thanks to our federal and local partners, especially the dedicated teams at ASPR, VITEMA, and VIDOH, whose swift commitment and responsiveness were instrumental in preserving continuity of care during this period. Their presence and expertise brought relief and benefit to our staff and patients.”

This event highlighted the strength of public health partnerships and the promise of telehealth during public health emergencies and disasters. By working together and leveraging cutting-edge tools, ASPR and its partners helped ensure that patient care was expertly delivered, even in the face of a complex cyber disruption.

Amy Keim joined ASPR one year ago as the Senior Medical Officer for Disaster Telemedicine. She has 20+ years of experience in emergency and operational medicine and an expertise in designing and implementing national/international operational medicine programs with a focus on leveraging technology to enhance medical readiness and improve patient outcomes in challenging settings.