Perhaps given her career trajectory it was inevitable that Dr. Dominique Wong would become a leading advocate for what she calls homeland security medicine.
The Center for Homeland Defense and Security alum, who graduated from the Executive Leaders Program with Cohort 2101 in February 2022 as the Ellen Gordon Award winner and now serves as a co-facilitator for the program, has worked for more than 25 years as an emergency physician in West Virginia.
During that time, the Cabell Huntington Hospital Emergency Department attending physician and chair of the hospital’s Medical Readiness Committee developed an interest in addressing medical interfaces outside of the hospital setting, such as law enforcement, mass gathering planning and response, disasters, and biosecurity.
Over the past decade, after her children left home, Wong said she became “overtly interested” in homeland security issues, particularly involving medicine, which led to her founding and chairing her hospital’s Medical Readiness Committee in an effort to enhance her community’s hospital preparedness and disaster planning and response.
A veteran medical director for emergency medical services (EMS) agencies including the Summit National Scout Reserve EMS system, she co-led on mass gathering event medicine direction and response, including for the 2019 World Scout Jamboree that drew about 50,000 participants from more than 130 countries—which Wong noted was the largest such event in history and was conducted in an “austere” setting.
And, Wong has expressed her affinity for law enforcement by working as a tactical physician and medical director of a tactical team in support of police SWAT teams, training law enforcement officers from the local to federal level and the military, as well as analyzing and understanding best practices to train law enforcement in evidence-based emergency response, along with serving in leadership roles with the American College of Emergency Physicians, Tactical and Law Enforcement Medicine Section.
Since the COVID-19 pandemic, she also served as clinical consultant for the state’s Wastewater Surveillance System, which keeps watch for the COVID virus and other public health interest targets, and is working with a team to explore wastewater surveillance as a potential tool for biothreat detection and pandemic understanding.
While Wong said those all seem like a “conglomerate of disparate activities,” she said her CHDS education “helped me understand the overarching theme of these activities—a concept I call homeland security medicine.”
She said she “stumbled across” the CHDS website before she applied for ELP and was “very surprised” when she was accepted, and then she said the educational experience “blew me away.”
“Honestly, CHDS is the pinnacle of everything I’ve done in my career,” Wong said. “Homeland security in large part is about saving lives, and that carries over to homeland security medicine.”
When ELP Director Sara Kay asked her to return to CHDS as a co-facilitator, Wong said she was excited to work with and learn from Kay, and fortunate that her hospital department’s medical director and hospital leadership have been “incredibly supportive,” noting that hospital officials are “very forward thinking” and committed to preparedness.
Wong said she has been focused on some examples that reflect the “utility of medicine integrated and aligned with homeland security.”
One example is her work identifying the best approach to time-sensitive injuries sustained by critical law enforcement and victims of the public in the high-threat situation not accessible to conventional EMS systems, she said, noting that FBI data indicates torso wounds are one of the leading locations of law enforcement fatal gunshot wounds, causing significantly more deaths than extremity wounds. Active killer preventable death studies suggest nonvascular chest wounds are a leading cause of preventable death, she said, adding that the data suggests the use of vented chest seals alongside tourniquets could prevent deaths in police and victim members of the public. The vented chest seal is inexpensive, takes up little space and is easy to apply, Wong said, adding that she has advocated for the use of vented chest seals alongside tourniquets and hemostatic gauze in her presentations and trainings.
While serving as a SWAT doctor and tactical medical team medical director, she said she began exploring data that confirmed her experience that only 5 percent of law enforcement line of duty deaths occur in the tactical setting. The typical setting for a law enforcement line of duty death is during routine patrol, she said, noting that means all law enforcement officers must have “some critical medical ability to bridge the gap from point of injury to professional medical care.”
Second, Wong said she’s concerned about the current hospital and medical system’s ability to respond to a homeland security threat.
“Though almost every victim of a terrorist attack or other disaster will be seen at a private sector hospital, the hospital system is not designed primarily for disaster readiness,” she said. “Nor do the economic forces behind the hospital system incentivize hospital or trauma center distribution maximized for disaster response. To effectively provide definitive care for a surge of patients, hospitals must be able to amplify space, staff, and supplies on short notice. Yet hospitals are closing and consolidating leaving many communities in hospital and trauma deserts.”
Wong noted that 1 in 5 counties in the U.S. are “hospital deserts,” defined as no hospital within a 30-minute drive, and are “trauma deserts” with no trauma center within a 60-minute drive.
“Emergency departments across the country are overwhelmed on a regular basis with many or most of the [ED] beds filled with boarded patients, those who are admitted and waiting on an inpatient bed often for hours and even days,” she said.
Wong added that supply chain shortages have also deeply impacted medical care by leaving shortages of equipment from PPE to ventilators and critical emergency medications, “clearly hindering the ability to provide routine care much less a surge of patients.”
She pointed to the impact of Hurricane Helene on the availability of IV and dialysis fluids as a recent example.
Staffing shortages are evident as well, she pointed out, so “even if physical hospital beds are available, without nurses and physicians they are effectively (and) functionally absent.”
She also noted the Association of American Medical Colleges (AAMC) predicts a shortage of up to 86,000 physicians, generalists, and specialists, by 2036, and burnout in physicians is rampant.
“The private sector medical system may be private sector, but the homeland security enterprise cannot afford to ignore it.”
Wong said she has been discussing a CHDS Master’s Program colloquium on medicine and homeland security with Master’s program lead Lauren Fernandez that would explore the current homeland security medical threat landscape and the medical system’s capacity to respond through discussions of private-public partnerships, pandemics and other biothreats, antimicrobial resistance, pathogen surveillance, medical threat assessments, medical education, hospital preparedness and other topics.
In fact, Wong has proposed a colloquium entitled “Medicine: A Homeland Security Blindspot?” in which she argues that the “homeland security threat landscape is changing, and many current and future vulnerabilities are medically focused.”
She said the colloquium is intended for Master’s cohort 2401/2402 and if chosen by the students, and could begin this fall.
“Homeland security needs to consider these issues and not have blind spots,” she said. “There’s an element of urgency. I don’t want to look victims of a homeland security disaster in the face and think the system failed them.”
Wong attended Cornell University as an undergraduate, Ohio State University College of Medicine for medical school, and finished her residency at Marshall University.
