Call of duty: WMC paramedic develops protocol for boy with rare disease

By The Pulse Oct 9, 2013

Roman LaDuke, 6, poses with the ambulance and fire crews who came to his Casper home Sept. 14. Roman has primary adrenal insufficiency and needs an immediate shot of Solu-Cortef -- a drug not carried on most ambulances around the country. His parents worked with WMC Paramedic Travis Lovelace, third from left, to get the drug approved for WMC ambulances.

Roman LaDuke, 6, poses with the ambulance and fire crews who came to his Casper home Sept. 14. Roman has primary adrenal insufficiency and needs an immediate shot of Solu-Cortef -- a drug not carried on most ambulances around the country -- if he goes into adrenal crisis. His parents worked with WMC Paramedic Travis Lovelace, third from left, to get the drug approved for WMC ambulances.

Roman LaDuke, 6, thinks it would be pretty nifty to ride up and down the street in an ambulance every day. He someday wants to work at Walmart so all those lined-up people will hand their money to him. Name a sport, and he likes to play it – wrestling, football, basketball, baseball, tennis and swimming.

One problem for this very typical, active boy: Sports could send his body into shock.  Roman, a first grader at University Park Elementary in Casper, has primary adrenal insufficiency, meaning his adrenal glands don’t produce cortisol – a hormone used to deal with stress. Dehydration, injury and other stressors could send him into shock. If that happens, Roman needs an immediate injection of Solu-Cortef.

The LaDukes -- Chad, Roman and Becky -- pose for a photo in their Casper home.

The LaDukes -- Chad, Roman and Becky -- pose for a photo in their Casper home.

His parents carry a syringe and a vile of the drug wherever they go. Roman’s school nurse knows how to administer the shot if needed. But, what would happen if the nurse was at another school? Or if Roman had an attack when his parents weren’t around?

“Roman is getting older now and he is more active, and he isn’t around us as much,” said Becky LaDuke, Roman’s mother. “We always assumed that if Roman wasn’t with us, that if an ambulance was called, they would be able to give the shot to him.”

Travis Roman drug

Giving Roman a life-saving dose of Solu-Cortef in cases of adrenal crisis is not like carrying an Epi-pen, the LaDukes say. They carrying this with them whenever they are with Roman, but worry about the times that they aren't around now that he is growing older and more independent.

Travis Roman bracelet

Roman's medical bracelet says he "needs a stress dose of cortisol."

Just a month ago, that wasn’t case. The LaDukes were shocked to learn that Solu-Cortef is not on the National Registry Paramedic Drugs list, meaning few ambulances in the country carry it. If Roman went into adrenal crisis, he would have been transported to the emergency room before getting the potentially life-saving injection – a waste of valuable minutes.

“There is no safe time. He needs the shot right then and there,” said Chad LaDuke, Roman’s father.

The LaDukes contacted Wyoming Medical Center. Mark Meyer, then the ambulance manager, spent a few weeks to research whether carrying Solu-Cortef was even possible. Meyer then assigned Paramedic Travis Lovelace to develop a protocol. Lovelace took just three days to research primary adrenal insufficiency and Solu-Cortef, write the protocol, develop the medical sheet, get doctor approval, obtain appropriate licenses and train WMC staff to administer the shot and respond to adrenal crisis.

Just four states in the country have ambulance protocols for Solu-Cortef in place while a handful of others have programs pending, according to The Cares Foundation, a national group working to raise money and awareness of Congenital Adrenal Hyperplasia. Colorado worked almost a year to get its program approved.  It took Wyoming Medical Center less than a month.

“It was amazing how fast they did it,” Becky said. “Travis went above and beyond what we could have ever hoped for.”

Lovelace has worked at Wyoming Medical Center about 5 ½ years (with a year off for school). His mother was an ICU nurse for 30 years and health care was a natural fit.

“Seeing how passionate she was really started me in that direction,” Lovelace said. “I think this is my niche – from just getting a blanket for someone in the ER to saving someone’s life. This is what I love to do.”

Lovelace didn’t stop with the drug protocol.

He went to the local dispatch to flag Roman’s address for his condition. He met with area fire departments – all Casper fire stations, and fire departments in Evansville, Mills and Natrona County – to tell them about Roman. If the boy had attack, those fire trucks might arrive first. And while firefighters can’t administer Solu-Cortef, they will know what to expect if Roman is in adrenal crisis.

Finally, Lovelace asked the LaDukes if ambulance and fire truck crews could visit Roman at his home. Lovelace recognized that stress is the trigger for an attack, and he wanted to show Roman what to expect if EMS vehicles ever respond to his house with lights and sirens blazing.

Travis Roman kids

EMS crews give neighborhood kids a tour of a Wyoming Medical Center ambulance, letting them try out the hydraulic guerney. When the crews came to show Roman LaDuke (shown at left) the ambulance and fire truck, the kids came running.

During the visit on Sept. 14, Roman held back at first. Then he opened up and no one could stop him, Lovelace said. About eight neighborhood children saw the vehicles and came over.

“They got to see my medicine bracelet and I sat criss-cross applesauce in the ambulance. It would be fun to ride it down the street every day,” Roman said.

Lovelace talked to Roman’s parents and grandmother, Susan Royston, a retired nurse, about Roman’s condition.

“Not very often do we get to go and just hang out and talk to the community,” Lovelace said. “Something like that did me, personally, a lot of good. And hopefully it will do Roman a lot of good.”

Roman was a healthy baby until he was 3 years old. He got sick with what his parents figured was the flu, but he then quit moving. His pediatrician, Dr. Robert Vigneri, told the LaDukes it was a case of dehydration and Roman perked up after his IVs. The same thing happened a few months later.

Dr. Vigneri ran more tests and couldn’t find a reason. He finally contacted the Denver Children’s Hospital which pointed him to primary adrenal insufficiency. He ran one more test to confirm the diagnosis, and Roman now controls the disease with cortisol pills three times a day.

“To look back on it, it really scares me. He was close to the D-word, you know what I mean?” Becky said. “I didn’t realize it back then. But now that I know, it is really scary how close he was.”

Roman will take the pills the rest of his life and will always need to carry Solu-Cortef. But the disease is manageable, and the LaDukes feel good knowing the drug is available if they are ever not around. They now want to work with the state EMS manager to see if they can install a statewide protocol. Wyoming has a lot of tourists, they say, and while adrenal gland diseases are rare, such a protocol could save lives.

Arrange an ambulance visit

Wyoming Medical Center crews will bring an ambulance to your daycare, preschool, elementary school or community group. To set up a visit, call the Community Development Office at 577-2388.

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