Abstract Introduction: A bomb blast in a hospital results in a many fold increase in the casualties. The affected health care in the region is the next challenge faced by the administration of the city. We discuss the challenges faced after a bomb blast in the civil hospital of Quetta, Pakistan on 8 August 2016. Methods: A retrospective review of the medical records of patients who were transferred by air to the Aga Khan University Hospital Karachi over a period of 86 h after the blast in Quetta. Results: Seventy-five patients were received in three separate waves; those received in the first wave were sicker than the following waves. Errors in triage and communication which could have been prevented were identified. Conclusion: Security of hospitals needs to be improved to avoid such incidents in future. The teams involved in the management of these incidents should be trained about triage and communication and its importance. There is need for designated trauma centers to take care of these incidents.