Adaptive entity-identifier generation for IMD emergency access

Recent work on wireless Implantable Medical Devices (IMDs) has revealed the need for secure communication in order to prevent data theft and implant abuse by malicious attackers. However, security should not be provided at the cost of patient safety and an IMD should, thus, remain accessible during an emergency regardless of device security. In this paper, we present a novel method of providing IMD emergency access, based on generating Entity Identifiers (EI) using the Inter-Pulse Intervals (IPIs) of heartbeats. We evaluate the current state-of-the-art in EI-generation in terms of security and accessibility for healthy subjects with a wide range of heart rates. Subsequently, we present an adaptive EI-generation algorithm which takes the heart rate into account, maintaining an acceptable emergency-mode activation time (between 5-55.4 s) while improving security by up to 3.4x for high heart rates. Finally, we show that activating emergency mode may consume as little as 0.24μJ from the IMD battery.