This article describes the non-operative management of five patients with ballistic abdominal solid organ injuries in a role 2E medical treatment facility. The selective non-operative management of ballistic abdominal solid organ injury is an accepted management strategy in high-volume civilian trauma centres, and appears to be equally safe and effective in the deployed military setting.

There is little literature about the epidemiology of injuries sustained while conducting cross country skiing due to the disparate nature of these athletes. The Royal Marines regularly deploys to Norway to conduct cross country ski-training and cold weather warfare training which presents a unique opportunity to analyse injuries sustained while conducting this sport. A total of 1200 personnel deployed to Norway in 2010 over a 14 week period. Patients who sustained injuries who were unable to continue training were returned to the UK. All data on personnel returned to the UK due to injury or illness was prospectively collected and basic epidemiology recorded. 53 patients (incidence 44/1000 personnel) were returned to the UK 20/53 (38%) of all cases were musculoskeletal injuries (incidence 17/1000 personnel). 15/20 musculoskeletal injuries were sustained while conducting cross country ski training (incidence 13/1000). Injuries sustained while skiing: 5/15 sustained anterior shoulders dislocation, 5/15 Grade 1–3 MCL/LCL tears, 2/15 sustained ACJ injuries, 1/15 crush fracture T11/T12, 1/15 tibial plateau fracture and 1/15 significant ankle sprain. The most common injury regardless of cause was anterior shoulder dislocation 6/20 (incidence 5/1000). Our results suggest that cross country ski training has a high injury rate requiring evacuation back to the UK. In our study group the high injury rate is possibly due to the rapid transition from non-skier to skiing with a bergen and weapon. Doctors covering Royal Marine training should have appropriate sports and exercise medical training, and rehabilitation units supporting the Royal Marines should expect sudden increases in referrals when large-scale cross country ski training is being conducted.

Complete and partial nerve paralysis can result from leprosy. The latter is more prevalent and results in lagophthalmos and corneal hypoesthesia. The former is characterized by loss of facial expression, deviation of the face to the nonparalyzed side, difficulty in chewing, and drooling, in addition to lagophthalmos and corneal hypoesthesia. Affected patients are at risk to develop blindness, as well as suffering social and economic deprivation because of the effects of facial nerve paralysis. Prevention of blindness and amelioration of the latter were successfully achieved by muscle transfer procedures, temporalis transfer to the eyelid, and masseter transfer to the mouth and nasolabial fold in small, minimally equipped hospitals in Africa.

We present the case of a 26 year old Indian base worker who attended the Role 2 enhanced hospital in Iraq with a case of leprosy. The patient presented four times over a 12 month period with non-specific pain in the right hand and forearm combined with a large lesion of dry skin and reduced sensation in the forearm. A clinical diagnosis of leprosy was made, which was subsequently confirmed as paucibacillary leprosy by skin smears sent to the UK. It was not possible to treat the patient locally and a recommendation made to the patient’s employer that the patient return to India to commence treatment.