PONE-D-21-04446

Sports safety matting diminishes cardiopulmonary resuscitation quality and increases rescuer perceived exertion

PLOS ONE

Dear Dr. Callender,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

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2.  Thank you for stating the following in the Competing Interests section:

'This study received the temporary loan of equipment from Laerdal Medical UK. NAC is

the owner of a commercial indoor climbing gymnasium. NBT is funded by a

postdoctoral fellowship from the Tobacco-Related Disease Research Program

(TRDRP; award no. T31FT1692). MIJ reports grants from Glaxosmithkline and the

Neuromodulation Society of the United Kingdom and Ireland (NSUKI) including

consultancy fees from TENSCare , outside the submitted work. There are no other

conflicts of interest to declare.

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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: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: I Don't Know

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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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: Mutliple objectives has been reported in the study, however the abstract doesnt mention about CPR preparedness

There is no limitation mentioned in the manuscript

Study has multiple objectives and includes a combination of research and survey. I would recommend reporting survey as separate manuscript and keeping objective simple

The survey portion of the study is definitely worth reporting but may be as research letter rather than original investigation.

Reviewer #2: I would like to thank the authors on their work to put this study and manuscript together. I enjoyed reading the manuscript. The topic and discussion of CPR surfaces is needed and specifically for environments such as sports venues. Below you can find my comments:

1- Overall challenge in the manuscript is it seems there are two main questions/themes the authors are trying to answer , which might confuse the flow and objective of the manuscript.

a. First one is the matting (fold 1 and 2) in the introduction section.

b. Level of CPR preparedness among commercial indoor climbing gymnasiums.

this caused a little bit of a confusion in the sample as it seems both samples are not the same…. In which it is almost having two studies. Have the authors considered having this manuscript focused on only one part, possibly aim 1 and 2? And have #3 separate paper (although may require more sample)?

2- The authors used the term Advanced Life Support (ALS), is this only CPR course (Basic Life Support by American Heart Association)? Or Advanced Cardiac Life Support). ? is ALS by ERC similar to BLS in AHA or ACLS?. If it was ALS=ACLS, what was the rationale behind selecting ACLS and not BLS/CPR ?

a. Not to mention that in the second study (survey on preparedness), the authors used the term BLS training instead of ALS. using one consistent term would be better.

3- Have the authors thought about using indoor venue staff as subjects instead of recruiting medical personnel , such as critical care, EM, etc? what

4- The study design is a crossover design, meaning subjects did multiple rounds of compressions on various surfaces , wouldn’t that cause some sort of fatigue? Even though they got some rest?

Suggestions:

1- Adding a descriptive table of the subjects characteristics.

2- Adding a study figure that shows exactly what subjects went through and how many were in each group etc. Figure would make it easier to visualize study design to the reader. Procedure section.

Reviewer #3: 1. In my opinion Figure 1 is not strictly required and should be removed from the publication.

2. Actual non-significant p values should be specified, rather than being provided as p>0.05

3. Was re-training attempted in the 5 females excluded from study. One would potentially hypothesize that their technique was inadequate and that re-training may have allowed participation in the study.

4. Interesting that Table 2 describes statistically significant differences. However the 95th % CI overlap for those described as different. Additionally, the means of all parameters described are within 1 SD of the remaining parameters defined. The raw data and statistics should be carefully re-checked.

5. Consider adding the 5 females excluded as an "intention to treat" analysis. Did this make any difference to your reported study findings. (I note that this data has been collected as per the attachment in your ofline data file providd

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: 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.

PONE-D-21-04446R1

Sports safety matting diminishes cardiopulmonary resuscitation quality and increases rescuer perceived exertion

PLOS ONE

Dear Dr. Callender,

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 06-July-2021. 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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

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.

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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)

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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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

Reviewer #2: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: I Don't Know

**********

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

Reviewer #2: Yes

Reviewer #3: Yes

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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

Reviewer #2: Yes

Reviewer #3: Yes

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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: My previous concern about multiple objectives in a paper (including survey and research data together) has been resolved by the authors. However the opening line in the discussion section still mentions about "also describe current levels of preparedness for CPR delivery among 222 indoor climbing gymnasiums" Please change this to accurately reflect the current objective of the paper.

Reviewer #2: (No Response)

Reviewer #3: Thank you for addressing my previous comments. I do not have further questions or comments.

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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: No

Reviewer #2: No

Reviewer #3: 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.

Sports safety matting diminishes cardiopulmonary resuscitation quality and increases rescuer perceived exertion

PONE-D-21-04446R2

Dear Dr. Callender,

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.

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Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE