PONE-D-21-35282Use of the Airstretcher with dragging may reduce rescuers’ physical burden when transporting patients down stairsPLOS ONE

Dear Dr. Takei,

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.

The reviewers concede that the Airstretcher may reduce the physical burden on EMT personnel compared to more traditional measures, although the current study design does present a few minor limitations. In a revision of the manuscript we would be keen on seeing the recommendations and comments f both reviewers tackled thoroughly.

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Academic Editor

PLOS ONE

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: Yes

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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

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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

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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: Comments

This manuscript reports the assessment of the effectiveness of the Airstretcher® device for decreasing emergency medical technicians’ physical burden when carrying patients downstairs. The Airstretcher was compared to two other instruments for transporting patients downstairs, namely the backboard and the tarpaulin stretcher. Please find below a few comments for your consideration. Line numbers in comments refer to the PDF file generated after manuscript submission.

Major comments

1. Lines 71-79. It is unclear whether all participants tested all 3 instruments (i.e. a repeated-measurement analysis), or if they were assigned to groups (i.e., independent-group analysis). I assume the latter was performed, but even in this case there is no description on how group allocation was performed (e.g. randomization?).

2. Lines 82-84. What was the order of testing the three instruments, fixed or random? What was the rationale for the choice of sequence?

3. Lines 88-89. It is unclear what is meant by ‘Most of the participants carried the manikin three times using the three types of stretcher’. How were these 11 participants selected? How the three repetitions for each instrument were aggregated (e.g. mean, smallest effort)?

4. Lines 130-132. Given the adopted scale (modified Borg scale) and vital sign (hear rate), I suggest using ‘perceived exertion’ rather than ‘physical burden’ across the manuscript.

5. Lines 133-134. How did you record the duration of the task?

6. Lines 136-137. Following comment #1, it is unclear what ANOVA was applied?

Minor comments

1. Abstract. Consider reporting SD alongside the means or the overall effect of the omnibus ad hoc tests (F-test and eta-sq values) rather than mean values with p values alone.

2. Lines 108-110. Why is it important to report the number of sold units in Methods section?

Reviewer #2: The submitted paper from Takei et al. proposes to investigate the potential benefits of using a Airstretcher – a newer device to aid EMT personnel when transporting incapacitated individuals – compared to traditional devices. In the experiment itself, students in EMT training performed the task of transporting a mannikin using either the Airstretcher or one of the more traditional devices. The outcomes measures included Borg’s RPE reporting, heart rate, and questionnaire responses. As reported by the authors, the Airstretcher may reduce the physical burden on EMT personnel compared to more traditional measures, although the current study design does present a few minor limitations.

1. The introduction was well-written and focused on the key aspects of the relevant background information for the study. One point of minor confusion may be lines 56-58, where the authors discuss the potential for falls, and how dropping the patient may lead to severe injuries. I would suggest including a sentence or clarifying here – given that incidence of drops/falls is not part of the present study, how does this relate to the physical burden of traditional devices versus the Airstretcher? Would the Airstretcher likely have a lower drop rate?

2. In the Methods Section (lines 77-79), this portion appears to be a bit repetitive. The specific details provided in this paragraph could likely be combined with the above sentences, to reduce unnecessary repetition.

3. In the Methods Section (line 133), it may be helpful to clarify further how the pulse rate was measured. This may help address questions about variability in the pulse rate measurements, etc.

4. The Results Section was very thorough, and provided detailed information about the outcomes of the study. One minor concern throughout was the readability – while minor, it may help with the ‘flow’ of the results section to simplify the naming of the four conditions with acronyms. In lines 152-153 where the four conditions are listed, parentheses could be included after each condition with an abbreviation or acronym. This would help reduce some of the longer sentences/phrases later in the results section, and clarify the overall section for the reader.

5. Also in the Results Section, it may help to ‘break up’ the Borg RPE section with a few subheadings. This would clarify to the reader what specific aspect of the Borg RPE reporting that the current section is addressing.

6. The Discussion Section was very well done, and easy to follow. One minor point would be the sentence in lines 247-248 dealing with muscle oxygenation. For those familiar with the relationship between muscle oxygenation and physical exertion/workload, this sentence does provide further evidence of the physical demands of transporting patients. However, this sentence may be more clear if the authors expanded upon the interpretation of the findings that muscle oxygenation differs for trained versus untrained individuals, given that the nature of this paper may interest readers who are not as familiar with concepts such as skeletal muscle oxygenation.

7. The Limitations portion of the Discussion Section was well-written, and sets up future directions in a concise but meaningful way. This section was particularly well-handled.

8. One concern in the Figures – Figure 2 presents a box-and-whisker plot for the Borg RPE values. However, this Figure is a bit unclear given the alignment of the dots and variability of their placement. It may help clarify the figure to align the dots over the condition they represent, or choose some other way to represent the individual data.

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Reviewer #1: Yes: Arthur de Sá Ferreira

Reviewer #2: No

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Use of the Airstretcher with dragging may reduce rescuers’ physical burden when transporting patients down stairs

PONE-D-21-35282R1

Dear Dr. Takei,

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,

Denis Alves Coelho, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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: All comments have been addressed

Reviewer #2: 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

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

Reviewer #1: Yes

Reviewer #2: Yes

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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

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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

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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: (No Response)

Reviewer #2: All my comments were addressed completely and thoroughly, and I have no further comments or revisions to suggest.

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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: Yes: Arthur de Sá Ferreira

Reviewer #2: No

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