PONE-D-23-26567Factors Causing Emergency Medical Care Overload During Heatwaves: A Delphi StudyPLOS ONE

Dear Dr. Paganini,

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PLOS ONE

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Additional Editor Comments:

Two referees have reviewed the paper and, in general, believe that the paper has the potential to be published. They have kindly provided some constructive comments for the authors to address in their revision. Please address the concerns seriously for consideration for possible publication.

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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: Yes

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: The authors conducted a Delphi study to derive the causes of emergency medical care overloading during heatwaves. Based on the analysis of the consensus 18 statements, the main factors are around patient

processing, identifying stakeholders, the population, primary care, as well as dedicated resources and bed capacity. My recommendation is major revision given my following comments:

(1) As a research study, evaluation/validation of the results is an indispensable section. However, the authors claim that the evaluation is their next step. From my point of view, evaluation/validation should be added to make this study solid and compact.

(2) The Conclusion section is weak since it just repeats the contents in the abstract. Please revise it to present a more comprehensive and stronger summary.

(3) The Discussion section is comprehensive, but the presentations need improvements. From the current version, it is hard to efficiently grasp the core findings and insights. This section should be more systematic.

(4) In Table 1, the mean values seem to reflect the significance of statements. Are there any insights from the mean metric?

(5) Based on the mostly focused aspects authors highlighted, Table 1 could be better if a column of statements' corresponding aspects (i.e. identifying stakeholders, the population, primary care, etc.) is added. In this way, each statement can be directed to the associated aspect.

In a word, I suggest a major revision. More efforts are needed to improve this study.

Reviewer #2: It would be valuable to frame a limitation section that explicitly addresses the geographical bias, given that a majority of the experts participating in this Delphi study are from high-income countries.

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Reviewer #1: No

Reviewer #2: No

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Factors Causing Emergency Medical Care Overload During Heatwaves: A Delphi Study

PONE-D-23-26567R1

Dear Dr. Paganini,

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,

Yong-Hong Kuo

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The concerns have been addressed. I recommend Accept.

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

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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

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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

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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

**********

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: After the revision and the authors' explanations, all my comments have been addressed. The structure of this study is clearer and much better. Therefore, my recommendation is Accept.

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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

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