Communication of preclinical emergency teams in critical situations: A nationwide study

Matthias Zimmer; Daria Magdalena Czarniecki; Stephan Sahm

doi:10.1371/journal.pone.0250932

Peer Review History

Original SubmissionJune 21, 2020
2 Nov 2020 Decision Letter - Bernadette Watson, Editor PONE-D-20-17178 Communication of preclinical emergency teams in critical situations: A nationalwide study PLOS ONE Dear Dr. Zimmer, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Dec 17 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Bernadette Watson, Ph.D. Academic Editor PLOS ONE Additional Editor Comments: I have read through the Reviewer's comments and completely agree with the comments. However, I do feel that the paper needs substantial editing before it can is publishable. Your method section is incomplete. You superficially describe the participants. You say in the discussion that they are representative but although you provide percentages with respect to gender, age and work experience in the reporting of your participants, I think you need to provide more information. Specifically, what is the breakdown of each profession and years of experience. It would be intriguing to know if the responses in some way differ between professions and experience. Again, this need only be descriptive but would bring your data to life. If there really are no differences then say so. Again, given that you are not conducting inferential statistics, why do you run non-parametric statistical analyses. The fact that you have such a large number of participants means you could have run inferential statistics. What was the reason for not doing so? It is fine to be descriptive but the overwhelming numbers in the tables is at odds with the emphasis that it is a descriptive paper. From what I can see the statistical analysis is redundant. I think you could detail the items used in the survey and state where they were sourced more fully. Why did you choose these questions? I assume they relate to the table headings but you do not introduce them in this way. What was your overarching research question under which these 53 questions sit? I also want to know how the survey was organised. Did the participants return in a prepaid envelope? What was the response rate? These details are important. One of the reasons that I believe you made mistakes with respect to the wrong information and table numbers is because you just have too many tables and they are presented unclearly. You need to reformat your tables so that they are not so cluttered. One way to achieve this would be to remove the confidence intervals. You are reporting descriptive statistics so simply report the percentages and numbers. This would make your tables more readable and uncluttered. Why are there no tables for the final three items discussed in the results? It seems strange given that you follow this format until that point. I wonder if you might consider combining results and discussion sections. After each table you could discuss the implications of what the numbers mean. This would improve comprehension of the paper and make for a more interesting and varied format. You can then conclude with a section on what it all means and what needs to be done. In your discussion you talk about more experienced members differing in terms of leadership etc but there is no such information in the tables themselves. In summary I am suggesting your reformat the paper and in so doing bring the data to life. I know this requires a great deal of work but if you are prepared to do this, it will increase the value of the paper immensely. Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. During your revisions, please note that a simple title correction is required: "Communication of preclinical emergency teams in critical situations: A nationwide study". Please ensure this is updated in the manuscript file and the online submission information. Please amend either the title on the online submission form (via Edit Submission) or the title in the manuscript so that they are identical. 3. Thank you for stating the following in the Acknowledgments Section of your manuscript: "We thank the medical directors of the rescue service, the Institute for Biostatistics and Mathematical Modelling at the Centre for Health Sciences, Goethe-University Frankfurt for their support and all participants for their participation in our study." We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: "The authors received no specific funding for this work." Please include your amended statements within your cover letter; we will change the online submission form on your behalf. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for doing this research and writing up the report for publication. It reads very well and is a very important underreported issue that requires attention. The manuscript is likely to appeal to communication scholars across medical. EMS and allied health, but also to social scientists interested in intergroup communication in healthcare. Some word and phrase choices confused me and made me question your statements and wonder if you have made some errors in reporting (a paragraph in particular L 148-167) because the table numbers were missing or wrongly matched to statements. Otherwise, I make a few suggested edits for clarity mostly and some for emphasis to enhance message. My edits are noted next and follow line numbers in manuscript (line number 'L'). Suggestions: L62 add reference? L66 edit to 'have an impact on patient safety' L99-106 copyedits needed capitalisation and periods L115 edit to 'patient care' L143 start sentence with 'Participants reported ..' L148-167 Review errors identified in text: Statements, table numbers and statistics L207 Consider '... communication standards and guidelines' (for clarity and emphasis) L209 unclear - pls review L215,216 consider edit to read '.. an insight into perceptions and experience of communicative behaviour and ..' L249 'completing incomplete' - confusing; consider rewording L251 reconsider word choice 'major aftermaths' - suggest change to 'major outcome risks' for example L259 suggest edit to 'However, the participants expressed a broad..' L261 for clarity suggest edit to 'binding communication standards and ..' if appropriate and true L270 review for edits word choice and order L276 suggest edit to 'The ability to communicate ..' for emphasis and clarity L280 replace 'as well' with 'also' L282 insert comma 'At the same time, a ..' L290 suggest edit to '... may have declined to participate ..'. I believe these edits will enhance the readability and flow and mitigate risk of confusion. Good work and good luck. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0250932.r001
Revision 1
15 Feb 2021 Author Response Dear Sir or Madam, Thank you for giving us the opportunity to revise our manuscript. We have carefully considered your suggestions and have made some extensive modifications. We have specified the description of the participants in terms of age, gender and work experience. The corresponding data are now presented in Table 1. Statistical analyses were performed under the advice of the Institute for Biostatistics and Mathematical Modelling at the Centre for Health Sciences, Goethe-University Frankfurt. We cannot retrospectively substantiate the rationale for omitting an inferential statistic. However, we agree with your assessment and have removed the references to statistical analysis. We have restricted ourselves to a pure description of the results. We have taken up reviewers´ suggestions and commented on the selection of items. As had been proposed we have described in detail the procedure of invitation to take part in the study and the process of data collection. That my help readers´ perception of the study. Participants were not contacted directly because we did not know them personally. Rather, we sent general invitations to participate to the Emergency Medical Services (EMS) stations. In parallel, we asked the EMS regional medical directors for additional forwarding of the invitations to the subordinate EMS stations. Not all directors supported us. Participation was via a link to the world wide web and involved only a small investment of time for participants. There was no compensation for costs and no other contributions. We cannot give detailed figures about response rate because it is not known how many employees in the EMS received the invitation. At your suggestion, we have revised the content and structure of the results and discussion sections. The order of the discussion is now parallel to the presentation of the results. We prefer to present the results and the discussion separately, since our hoped-for target group is from the medical field and is strongly accustomed to this form of presentation. Unfortunately, we did not adequately describe the context in the acknowledgement. The regional medical directors of EMS did not fund us, but authorized letters of invitation in their counties and forwarded them to the subordinate EMS stations. The Institute for Biostatistics and Mathematical Modelling at the Centre for Health Sciences, Goethe-University Frankfurt helped collegially as we are faculty members of Goethe-University Frankfurt and this is the mission of the Institute. There are no financial or other dependencies between us and the institute. We kindly ask you to reassess the facts. Reviewer 1 We thank you for the detailed review comments and have carefully edited all points. At the same time, we have redesigned result and discussion section, respectively, to make them easier to understand. With the restriction to a purely descriptive presentation of the results and after the redesign of the results, all existing data are available to you. We hope to have responded intensively to all your suggestions and hope for an acceptance of our article in PLOS ONE. With best regards Matthias Zimmer Daria M. Czarniecki Stefan Sahm Attachments Attachment Submitted filename: Response to reviewers_final.docx https://doi.org/10.1371/journal.pone.0250932.r002
22 Mar 2021 Decision Letter - Bernadette Watson, Editor PONE-D-20-17178R1 Communication of preclinical emergency teams in critical situations: A nationwide study PLOS ONE Dear Dr. Zimmer, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 06 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Bernadette Watson, Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): The reviewer has noted the improvements to this paper and its importance. I concur with the reviewer's opinions. I would ask you to take note of the small revisions recommended. They should not take long. Regards [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Many thanks for considering and integrating suggestions offered in my initial review of the manuscript into the current version. I thank you for your letter, and I accept your explanations with gratitude as these have helped my understanding of the purpose, execution and results of the research. The current manuscript is informative, non-biased, reads well, is clear, and delivers an important message for all stakeholders - EMS staff, health communication educators, health leaders, patients and the friends and families that support them. I note there are some very minor edits remaining (tense consistency and punctuation). Please read and edit or reconsider the following (indicated by line number). Square brackets indicate suggestions and questions about word use. 27 single-blinded study 34 (Delete 'Again') Of note, 96.3% 46 At the same time, (add comma) 55 ...newly combined daily. In addition, ... 71 ...investigate perceptions of communication deficits ... 72 ...management were to be identified. 76 single blinded 79 (Delete 'made a call')... promoted the study in an EMS ... 80 ...heads of EMS stations were called upon to make... 81 ...collect responses to the questionnaire. 128 ??? What do you mean by participated 'equally' as you give different percentages! 143 (149 & 154) Tables. Use the word 'rarely' not 'rare' (it's an adverb not adjective). Add periods to end of statements in tables. 146 ...closed-loop communication (i.e. message given, repeated, confirmed). [I think it's better to provide a little information to the reader about what closed-loop communication is in case they don't know. So please add this in parentheses as shown.] 149, 154 ['rarely' and periods as above stated] 158 Participants justified... 160 did not want... 172 workers, interviewees... 182 ??? [The first, and third sentences seem to be contradicted by the fourth. Review and rewrite for clarity. For example make clear that the percentage refers to units in hospitals (?) but we didn't know about EMS experience because it is not yet published - this is my guess at least.] 194 ...conclusion. However, ... 200, 202, 207 closed-loop 219 ...introspect 230 ...risks 253 As well, ... 257 ??? [More or less than what? This is unclear to me as it sounds like a comparison but I am guessing.] 259 ...and the human factors involved should occur. 266 [This is a suggestion only: some of the data and your statements refer to shame (e.g. line 230), and I wonder if shame may have been a barrier to participation for those with an experience of communication failure (e.g. line 136; 72% experienced communication failure). Not to conflate the issue, but shame is a predictor of poor mental health and suicide ideation. As such, if shame was a barrier to participation, there are vulnerable service providers keeping quiet about communication failures and who may be at risk.] Thank you for considering these final edits (there may be others - please review carefully!) Congratulations on your research success, and thank you for taking the time to ensure the scientific community is informed of this important factor in EMS delivery. I hope the publication receives the attention it deserves, and supports EMS staff, their own selfcare, and patients receiving emergency services into the future. Kindest regards, Lori. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Lori Ellen Leach [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0250932.r003
Revision 2
9 Apr 2021 Author Response Dear Sir or Madam, Thank you for giving us the opportunity to enhance our manuscript. We have taken up all reviewers´ suggestions and have made precise corrections. In particular, we have clarified two passages in the discussion. We thank you for the productive cooperation and hope for an acceptance of our article in PLOS ONE. With best regards Matthias Zimmer Daria M. Czarniecki Stefan Sahm Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0250932.r004
19 Apr 2021 Decision Letter - Bernadette Watson, Editor Communication of preclinical emergency teams in critical situations: A nationwide study PONE-D-20-17178R2 Dear Dr. Zimmer, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Bernadette Watson, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you for your attention to these revisions. The paper now reads well and is a valuable contribution to the area. Reviewers' comments: https://doi.org/10.1371/journal.pone.0250932.r005
Formally Accepted
23 Apr 2021 Acceptance Letter - Bernadette Watson, Editor PONE-D-20-17178R2 Communication of preclinical emergency teams in critical situations: A nationwide study Dear Dr. Zimmer: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Bernadette Watson Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0250932.r006

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