Back up of C and D drives with running SQL databases?

There is no usage or data entry betwee 10pm and 6am, so if I run Acronis at that time will it copy all the SQL database files acccurately?

Deepak - I'd say this needs to be tested in a non-production environment for verification to be sure.  

Using Microsoft VSS, it "should" be possible to backup an open SQL database, but i wouldn't trust it - lots of moving parts in SQL and I would feel most comfortable relying on the SQL tools to create the database backups.  

In my environment, we have SQL create copies of the database at different times of the day (SQL Server scheduled backup using a SQL Server Agent job) and then backup those files with varying third party backup tools like Acronis.  These can be done anytime of day - even when the database is in use.  Then use Acronis to backup the system whenever you want and it will caputure those backup files. Worse case, you may be able to backup everything with Acronis and restore in one swoop, but if not, then you restore with Acronis and then do a second restore in SQL using the recovdered SQL database backup file - at least you have options by using both available methods.

http://solutioncenter.apexsql.com/how-to-create-a-sql-server-scheduled-…

do I need to restore to the main image first? See attached image.

No.  If you double click on a .tib file (let's say your last one which is b1_s3_v1, it should open up in a Windows explorer view where you can copy and paste from the backup to your machine.  Or, you can right click that backup file and "mount" it as a drive letter and copy/paste from it too.  You can also use your offline recovery media to do full system, parition or file/folder backup and just navigate to the version of the backup you want to work with and as long as all of the other parts that came before it are in place and in good shape, it should put them all together to give you the data of the backup version you select. 

If a hard drive crashes, and I need to restore, do I need to load Windows, then Acronis and then restore? Or can I load a new hard drive direct from the image either on cloud or from a USB drive?

Nope, that's what your offline bootable recovery disk (.iso can be burned to CD or DVD or you can create a bootable flash drive using the media builder from within Acronis).  If you can boot the recovery media, you can restore without Windows. This is another one of those things you should test in a non-production environment to become familiar with so you know how it works and what the results are before you get in a sticky situation. 

Lastly, can I make images to both cloud, and USB drive? And, ALSO, say to another networked computer in the same building?

Yes.  You can store yoru images anywhere you want as long as you have the permissions/access.  However, you can only have one backup location per backup task/job in Acronis.  So use one job for Cloud, One job for a local storage and one job for remote storage.  Alternatively, you can copy existing backup jobs (say the ones created to your local USB drive) to another network share using scripts, manual copy/paste,etc.  And, there is an option under the backup job "advanced" tab called "backup reserve copy".  This is another way for you to automatically copy the backup file to a second location in an automated fashion. 

Wow, thanks so much. Will take me a while to digest the info.

I cant use SQL to create the backups as the software guys who supplied my hospital software are refusing to give me the password.

They say they will do automatic backups. They are doing it but last time the backups were not restorable, and hence I want an additional solution.

I used 'SQLBackupandFTP' which I found on the net to back up the data bases. Is this a reliable software?

Bummer that the SQL guys won't help out - I'd get that in writing and make sure they're held accountable and not you in case there is an issue.  There are tons of online forums that state that it is not a good idea to backup SQL databases while in use - hence a good need to backup the database with SQL tools as that gives the best chance to recover.  The other alternative would be to manually backup the server with it being offline and SQL shutdown, but that is all a manual process so would stink if you're a day shift person and there is no swing or night shift to do this during off hours on a regular basis.

Never tried SQLBackupandFTP so can't really say much about it.  Ultimately, if the SQL guys are taking regular backups of the database with SQL Management server and you're taking backups of those backups, your chances of recovery should be pretty good.  Might want to ask them how often they backup the database, where and when.  If one of those is to the local system or a location you can access from Acronis, you should be able to try and back those up yourself too. 

Again though, using VSS, Acronis "should" be able to back-up the open SQL database, but I wouldn't count on it as the sole/only option.  It would be pretty hard to recover that database short of doing a full system restore and it's still a bit risky just because the SQL database is in use.

Good luck!