Pandu Ranga Reddy did not notice the bicycle parked in front of the A1 Mirchi centre, the roadside snack bar in Hyderabad’s Dilsukhnagar where he and two of his friends had repaired in the evening. The Mirchi centre in front of Konark theatre had attracted the usual peak hour crowd that doesn’t thin out till dark. Anyway, there was nothing remarkable about the old Atlas-make cycle parked among dozens of other two wheelers. According to police reports, CCTV cameras covering the area showed a cyclist clad in a T-shirt entering the Konark theatre lane around 6.30 p.m. He waited at the traffic umbrella and then moved towards the theatre.

Police say the footage showed a plastic bag dangling from the rear carrier. The cyclist was accompanied by a pedestrian, who later dropped out of sight of the camera. Strapped to the rear was an Improvised Explosive Device (IED) with the timer set to a few minutes after 7 p.m.

Dilsukhnagar is a hub for educational institutes, especially private coaching centres for engineering subjects. Pandu Ranga, his cousin Mohan Reddy and a friend, Rajendra, were returning from a coaching class. The three engineering students reached the theatre some time before 7 p.m. They did not plan to stay there long. A quick snack and the three friends would separate and head home. Pandu Ranga, who is from Nalgonda district in the Telangana region of Andhra Pradesh, stays in a rented room in Swaroop Nagar. He intended to take a bus. The friends paid for the snacks and were leaving when they heard the first explosion.

Around 7 o’ clock, a loud explosion from the direction of the Dilsuknagar bus stand disrupted traffic in front of the theatre. In a moment, chaos enveloped the crowd of pedestrians, bystanders and motorists. There were scattered shouts that a transformer had exploded. Other voices shouted that a gas cylinder had exploded. Deciding that it was time to move , Pandu Ranga turned and walked away from the Mirchi Centre, his friends following behind. It was a mistake.

In taking those few steps Panduranga had cut down the distance between himself and the cycle carrying the IED. Six to 10 minutes after 7 p.m., the device went off and a powerful second explosion ripped through the area. Shrapnel from the bomb casing ripped through the flesh of men, women and children who collapsed like nine pins. Mohan Reddy and Rajendra escaped the worst. Their injuries were comparatively minor. Panduranga, however, had walked towards the blast wave, and deadly projectiles flying from the bomb tore through his face, arms and limbs. He remembers blinding pain and falling forward among a heap of bodies.

“I tried to turn and look for my friends. I couldn’t see them. There were dead and injured people all around me. Both my legs were bleeding. I screamed for help for several minutes. Then some young men came and pulled me off the road,” he says.

Though his injuries were extensive, Pandu Ranga did not lose consciousness. He vividly recalls the scenes of chaos: The near-stampede as panicked people fled helter-skelter fearing another blast, ambulances with blaring sirens that reached the spot a few minutes later and the white police jeeps with men in khaki. As police struggled to clear the traffic, some of the more stout-hearted bystanders helped the injured.

Soon, helping hands led Pandu Ranga towards an ambulance. But the ambulance was full and he was turned away. In a few minutes, a passing autorickshaw was flagged down and the strangers assisted Pandu Ranga into it.

“I told the driver that I had ₹100 in my pocket and that he could have it if he wanted. I told him to take me to Yashoda hospital in Malakpet. He wanted to take me to Osmania hospital. But I told him to take me to Yashoda. I knew it was nearer.” That decision ultimately saved Pandu Ranga’s life.

At Yashoda hospital, the day was drawing to a close for Dr Surendra Reddy, one of the general surgeons on duty. He usually ended his shift at eight, but that day he was planning to leave at seven and head out to Dilsukknagar. He wanted to visit the Sai Baba temple there. It was ten minutes to 7 p.m. If he had left, he might have been one of the victims of the twin explosions.

But one of his patients was serious and he was attending to him when the news of the blast came in. His first reaction was one of relief. Then the professional in him took over. As he watched the news of the suspected terror attacks scrolling on news channels, his mind was trying to assess the situation. Dilsukhnagar was barely 2 km from the Malakpet hospital. In a matter of minutes, patients would start arriving. There was no information about the intensity of the blasts or the number of victims. They could be dealing with anything from a few minor burns and flesh injuries to a mass disaster with multiple kinds of injuries. They had to be prepared for any scenario. Luckily, they had a plan in place.

Dr S S Kumar was in-charge of the emergency ward that day. As soon as he heard the news, he rang the medical administrator-in-charge of the hospital on his personal mobile. Dr Kumar had come to the same conclusion as Dr Reddy. They had no information on the scale of the crisis, but any time lost would prove crucial if they were faced with a massive influx of patients.

The hospital had taken patients during the terror strikes in Gokul Chat Bhandar and Lumbini Park in August 2007. However, because of the distance, only a few patients with relatively minor injuries were brought to the hospital. In 2011, the Yashoda hospital group received accreditation from the National Accreditation Board for Hospitals (NABHR).

In a matter of minutes, patients would start arriving. There was no information about the intensity of the blasts or the number of victims. They could be dealing with anything from minor burns and flesh injuries to a mass disaster with multiple kinds of injuries. They had to be prepared for any scenario. Luckily, they had a plan in place.

Under NABHR guidelines, the hospital had put in place an emergency plan for disasters called “Code Red”. He intended to set the plan into operation. Once the medical administrator gave formal approval, Dr Kumar informed the communications room that the hospital was at Code Red.

At 7.11p.m by the hospital’s clocks, the Public Address (PA) System started blaring out the alert message “Code Red. Bomb blast at Dilsukhnagar.” The message was repeated at 20-second intervals, signalling personnel of all departments to initiate pre-arranged procedures for the emergency.

In imitation of military parlance, the core medical team responsible for Code Red was named the Rapid Action Medical Team. It had 15 surgeons, consisting of general surgeons, plastic surgeons, cardiothoracic surgeons and orthopaedic surgeons. Also there were anaesthetists, trauma-care specialists and specialists in branches like internal medicine.
Once the announcement came over the PA system, members of the team started coming down to the emergency ward. Around 25 doctors were on duty, and many of them called off-duty colleagues informing them about the emergency. Once Code Red was announced, two operators in the communications room started calling doctors and other staff, including many on their way home after work.

In the next 15 minutes, doctors, nurses, attenders, security and house-keeping staff would leave their homes in various parts of the city for the hospital. Many of them had heard the news on television and come in on their own. Among those who got a call at home was Dr Sreekanth Reddy, senior doctor in charge of the emergency. He had already caught the news on television when hospital security confirmed the bomb blast at Dilsukhnagar. Within minutes he was driving to Malakpet. Dr Reddy was in charge of the periodic mock drills the hospital conducted as training for Code Red situations. Every three months, a surprise practice drill would be organised by Dr Reddy, with hospital staff smeared with artificial blood playing the role of patients.

The hospital had last conducted such a mock drill in December. In the imaginary scenario, a bomb blast had taken place in the afternoon. Ambulances from the hospital had rushed to site to collect the 15 hospital staff who were playing the blast victims. In the hospital Code Red was on. The casualty assessment of this exercise was eerily close to the February 21 mark. In the mock drill the hospital had prepared itself for an blast in Dilsukhnagar.

While Dr Kumar and his team attended to a couple of patients already present in the casualty and moved them to the general ward, to clear beds for the arrival of the patients, other hospital departments were also swinging into action. The nursing superintendent had been informed of Code Red and extra nursing staff were called up from the nearby hospital’s nurses’ hostel.

The security staff began clearing the waiting area of the hospital as well as forming a cordon around the hospital. Vinod Kumar, the chief security officer, had set the wheels in motion the moment he heard the news. A few minutes before Code Red was announced, Vinod had assembled his team of 60 security guards and sent them to their various stations. Extra manpower had been requisitioned, and 40 off-duty guards would reach within half-an-hour.

With the blast site so near, Vinod expected crowd control to be his major problem. He deputed Rajiv, one of his subordinates, to stand by the entrance with a digital camera and photograph the patients as they were brought in. These photographs would be displayed on the help desk computer for the help of people seeking out their friends or relatives among the blast victims.

The first patient came in at 7.16 p.m. The hospital received 16 more patients in the next 45 minutes. Most came in auto rickshaws or private vehicles. A few were brought by ambulance. One patient with minor injuries, who refused to be admitted overnight, was discharged after treatment.

The housekeeping department was also following the same procedure. Ayahs, ward boys, couriers and cleaners already present at the hospital were given specific tasks to support the doctors, while more staff were called up by the communications personnel. Stretchers, wheelchairs and trolleys were frantically rushed to the ramp outside the hospital entrance and attenders stood there ready to move patients to the emergency ward.

Once security staff had cleared the waiting area of people, the housekeeping staff moved in. The rows of black metal chairs, which out-patients waited in for consultations, were briskly moved off. At the rear of the waiting area, standing against the wall were two grey, metal cupboards. They contained emergency medical supplies meant for Code Red. It was stocked with basic medicines like painkillers, tetanus shots and antibiotics, besides IV fluids, stitches, cotton rolls, bandages and so on.

As the chairs were being moved, the support staff was bringing in beds, bed stands and IV stands. The main emergency room had six beds. As part of Code Red, the waiting area would be converted into a second emergency room that could house up to 12 patients. The chairs had just been taken away when the first patient arrived in an autorickshaw.

Attendants loaded the bloodied body of the young woman on to a stretcher and almost ran to the emergency room. A call from the help desk alerted Dr Kumar and the emergency room staff. It was 7.16 p.m.

[T]he young woman was Rajitha, a 22-year-old MBA student. Though she had been in Hyderabad for more than a year, she had never visited Dilsukhnagar before that evening. She was there that day on an assignment to collect field data for a college project which involved building a profile of the business operations of a private company in the city. A consultant to the company had agreed to meet her in Dilsukhnagar. Rajitha wound up her interview sometime after 6.30 p.m and walked to the Dilsukhnagar bus stand.

The bus stand is a major depot connecting to several important areas in Hyderabad. That day it was particularly crowded because of a traffic diversion. Rajitha was waiting for a bus back to her hostel in Chandrayangutta, in the old city, when the bomb went off. Her right leg was crushed below the knees in the blast wave and she crumpled to the ground. She swooned from the pain.

She returned to consciousness in a few minutes, to unimaginable pain and a cacophony of shouting and screams. She recalls a haze of black smoke and bewildered people gazing at their own bloodied hands and limbs. Several strangers who were unhurt had taken out their mobile phones and were clicking pictures of the devastated bus stand. None of them came to help. Rajitha remembers lying on the ground and screaming for help for several minutes. Finally, a young man heard her cries and came to assist her.

Rajitha would learn later from the doctors who operated on her that a delay of 10 to 15 minutes could have proved fatal. The young student, Naresh, managed to get her brother’s mobile number even as he bundled her into an auto. As the auto sped towards the Malakpet hospital Rajitha knew Naresh had talked to her brother.

She remembers reaching the hospital, khaki-clad attenders and blue clad security guards lifting her out of the auto, putting her on a stretcher and carrying her into the emergency room. After that, as the doctors started dressing her wounds and giving her painkilling injections, her memory became hazy and fragmented.

The Malakpet hospital received 16 more patients in the next 45 minutes, the majority within half an hour of Rajitha. By 7.16 p.m, Vinod despatched two ambulances with anaesthetists aboard to Dilukhnagar, but they couldn’t reach the blast site because of traffic jams. Most of the patients came in auto rickshaws or private vehicles. A few were brought by emergency service ambulances. One patient with minor injuries, who refused to be admitted overnight, was discharged after treatment.

Sixteen patients underwent surgeries, seven on that very day. By 7.23 p.m, 10 patients had been brought in to the primary emergency care room, including two grievously injured—Pandu Ranga Reddy and Amrutha Ravi Kumar. The emergency ward had become the site of frenetic activity. Phones kept ringing, and doctors and nurses rushed to answer. Every couple of minutes, the glass doors were pushed aside and the blood-soaked bodies of new patients wheeled in on trolleys by motley groups of attenders, security guards and nurses. Once in a while, a single attender would bring in a patient on a wheelchair.

Before 7.30 p.m., relatives and friends of the victims who had been directed to the casualty section by the front desk were coming in. They were followed by police officers who wanted to question the conscious victims for details of the explosion.

At the entrance to the ward, doctors in white coats or green and blue scrubs started triaging the patients. In case of mass causalities where medical resources have to be prioritised, cases are divided into different groups after a preliminary examination.

Patients brought dead or clinically dead are tagged black. None of the blast victims were brought dead to the hospital. The more serious cases, which needed immediate attention, were tagged red and a red ribbon was tied to the patients’ wrist. Yellow ribbons marked patients who needed care in the intermediate future, while green ribbons went around patients with minor injuries whose condition was stable.

Patients tagged green were shifted at once to the second emergency room created in the waiting room. Most had shrapnel lodged in their body. Almost all had multiple fractures. Many had crushed limbs and arms. Some were bleeding profusely from injuries to the head and face. Others had internal injuries where the metal objects packed by the terrorist into the bomb casing had penetrated intestines and other organs.

The doctors first checked for the ABC of emergency care: Airway access, breathing and circulation. Once they had ensured that the patients’ airways were free and that breathing and blood circulation were normal, the doctor would try to stabilise the patient. Two teams of doctors and nurses attended each patient.

While one team dressed the wounds, the other gave tetanus shots, painkillers and other medications. Fluid IV was started for all the patients to prevent them from going into hypovolemic shock (a condition where loss of blood or fluids leaves the heart unable to pump enough blood in the body).

Patients who were conscious were asked for names, addresses and contact details. Those who could talk were asked for details of their medical history. When patients were able to give their identities, the support staff would immediately convey the information to the help desk, where the updated information would be cross-referenced with the photographs of the patients.

Many patients still carried mobile phones, their screens smashed in the blast. Some were still working. The medical staff tried pressing the call button to connect with the last dialled numbers. With mobile signals blocked in many sectors of the city after the blasts, often the calls couldn’t go through.

When Dr Sreekanth Reddy reached the hospital, he was taken aback for a moment by the number of patients already there. He observed, however, that the Code Red protocols had been followed almost to a T by the medical and hospital staff. As he joined Dr Kumar in supervising the stabilisation efforts, clinical diagnosis was already underway for the emergency patients. Blood test samples rushed to the labs had come back and intravenous blood transfusions started.

Blood had been brought from the hospital’s blood bank but with the number of patients and the extent of the injuries it wouldn’t last long.

The radiology department had mobilised portable X-ray and ultrasonic scanning machines and they were wheeled in besides the patients’ beds. This allowed the doctors to get pictures of the extent of orthopaedic injuries as well as the locations of foreign objects inside the body. Patients with head injuries however, had to be shifted to the radiology department for CT scans.

By 8.30 p.m, the most serious patients, Rajitha, Pandu Ranga and Ravi Kumar were shifted to the operating theatre. After the patients were stabilised, they were shifted to the ICU and later to the operating theatres. By the time the first surgeries were underway, Dr Sreekanth had left the emergency ward to help man the ICU where a team of critical care specialists monitored the patients constantly. He left two doctors behind in case more victims came in.

A huge crowd had gathered in front of the hospital. News flashes had gone out that victims of the bomb blasts had been taken to Osmania hospital, Yashoda hospital in Malakpet, Kamala hospital and Omni hospital in Dilsukhnagar.
People who knew their relatives were in Dilsukhangar at the time of the blast but had no information about their whereabouts were there to check if they had been brought to the Malakpet hospital. So had people who were informed by the hospital that their relatives had been admitted to the casualty.

OB vans and camera crews hungry for news and visuals of the victims lined the road. Newspaper reporters tried to talk their way past security guards instructed not to let them in. But the greater part of the crowd was local people unconnected with the blast, who had gathered out of curiosity.

Many tried to get into the hospital, leading at times to altercations with security. Policemen often drove off the crowd milling around the hospital ramparts by brandishing lathis. Relatives of the victims were screened at the entrance and led to the help desk, where they were shown photographs of the injured. Once they identified them, they were directed to the emergency ward. Soon MLAs, politicians, ministers and other VVIPs started to arrive, followed by security personnel. The media almost went berserk, insisting that they should be allowed inside.

As part of Code Red protocol, Vinod had put 40 members of his security staff on standby for donating blood. But with the flood of visitors inside the hospital and the additional support duties the security staff had taken on, he could ill-afford to cut down his team strength in such huge numbers.

He started to look for volunteers among the people gathered outside the building. A young man in a black shirt was already trying to organise volunteers to donate blood. Vinod only remembers the man’s surname—Khan. But he remains grateful for the load he took and the time he saved.

Vinod left a man to coordinate with Khan and soon 30 volunteers in two batches were conducted to the blood bank to collect A+ blood. More than 60 people donated blood that day. Many of them were students from engineering colleges whose friends had been caught in the blast.

The last batch of operations began at 11.30 p.m. and lasted into the early hours. A team of general, plastic, cardiothoracic, orthopaedic and laparoscopic and neurosurgeons working together performed seven surgeries that day. Surgeons who went home a few hours before daybreak were in again the next day by eight to start on the next batch of patients. Many patients required multiple operations over the next week. The hospital lost two patients. Joga Ram expired on the same day of the blast. The doctors had little hope of saving him.

Though neurosurgeons performed cranial surgery, the skull injury was so severe that intracranial pressure squeezed the brain stem through the spinal cord. The medical team was much more optimistic about Ravi Kumar, bleeding from the stomach when he was admitted. But when surgeons opened his abdomen they realised that the injury was much more massive than ultrasonic scans had suggested.

After the surgeons removed the metal object that had pierced his intestines, he was put on ventilator. He showed enough progress that they attempted to take him off ventilator support on the third day. However, his body did not cope and he developed sepsis. After being kept alive for two weeks on ventilator support, Ravi Kumar passed away after multiple organ failure. He was 25. Rajitha lost her right leg. Panduranga Reddy underwent multiple operations which saved his life but he lost his left eye and left leg.

The Andhra Pradesh government announced a payment of ₹6 lakh as rehabilitation for those who died or suffered permanent disability in the blasts. Seventeen people were killed and over 100 injured in the terror attack.

The doctors at the Malakpet hospital have been giving counselling to Rajitha and Pandu Ranga, who have been shifted to the general ward from the critical care unit. They have tried assuring them that they can lead an almost normal life with the use of prosthetic legs. The hospital provided free treatment for all the victims. But the post-discharge treatment and procuring prosthetic limbs will set back both the youngsters monetarily. Their families are waiting for the government to pay the promised rehabilitation amount. They have seen government officials hand over cheques to other victims when they were discharged, and are hopeful.

Lying on his bed, Pandu Ranga says little. As he tells his tale, his bandaged face is grim and hopeless—devoid of expression, even anything that can be construed as sadness. His father who is a farmer, has decided to move the family to Hyderabad and stay with his son during his treatment.

The doctors have advised them to use a German made prosthetic limb, rather than the inexpensive Jaipur foot. German prosthetic legs give much greater mobility and flexibility and are even used by athletes in the paraplegic Olympics. However, the price is hefty. His family has taken out advertisements in several regional news channels and newspapers asking for contributions. The channels carried the ads for free, but so far they have received only ₹25,000. Rajitha’s father is hoping that the government will give his daughter a job.

The ward nurses say Rajitha, who had been depressed following the amputation of her leg, has regained some strength in the last few days. Just like Pandu Ranga, she doesn’t think of the men whose violent act maimed her for life. But she has started thinking about the future. She wants to continue her studies. And get a job.

During her third day of convalescence, the Prime Minister visited the victims in the ICU. She spoke to him in her broken Hindi. She told him that she wants a job. She says the PM told her that she would get a government job. An official accompanying the PM took down her name address and other details. No one has contacted them after that about the job. But Rajitha and her father are hopeful.