In open fracture with visible bone, which sequence of actions is recommended in the field?

• A. Control bleeding, cover wound with sterile dressing, immobilize with splint, evac promptly
• B. Evacuate, Cover wound, Control bleeding, Immobilize
• C. Cover wound, Immobilize, Evacuate, Then Control bleeding
• D. Immobilize with splint, Control bleeding, Cover wound, Evacuate

Answer: (A)

In open fracture with visible bone, the highest priority is stopping life-threatening blood loss, then protecting the wound from contamination, followed by stabilizing the limb, and finally evacuating promptly for definitive care. Start by controlling the bleeding—apply direct pressure and, if needed, a tourniquet per protocols—to reduce the risk of hemorrhagic shock. Next, cover the wound with a sterile dressing to limit contamination and support clot formation. Then immobilize the limb with a splint to prevent further injury and ease transport. Finally, evacuate quickly to a facility where surgical debridement, stabilization, and antibiotics can be provided. This sequence minimizes blood loss and infection risk while ensuring safe transport. Other sequences can delay bleeding control, wound protection, or immobilization, increasing risks during transport and at the receiving facility.