If a casualty has a fracture that protrudes out of the skin, what is your primary concern?

When dealing with a fracture that protrudes through the skin, or an open fracture, the primary concern should be controlling life-threatening bleeding. Open fractures can lead to significant blood loss due to the exposed bone and surrounding tissue, which may damage blood vessels. Therefore, assessing and managing any potential hemorrhage is critical to stabilizing the casualty's condition.

Controlling bleeding takes precedence, as life-threatening situations can quickly escalate in the absence of adequate circulation. Once bleeding is under control, other considerations such as immobilization of the fracture, management of infection risk, and pain relief can be addressed, but ensuring that the casualty is not experiencing critical blood loss is the first and most urgent concern.