Introduction First aid is a concept of first hands-on measures performed in a medical emergency by laypersons. The goal is to teach people how to recognize a medical emergency and start qualified action by providing measures of basic life support such as performing cardiopulmonary resuscitation. Other topics are injuries and burns, shock, unconsciousness or heart attack. 1 2 3 5 3 6 8 In a prospective study we tried to test the hypothesis that stroke information integrated in first aid training will improve knowledge of laypersons. Additionally a concept of first action will increase motivation and acceptance will be quite high with participants. Methods Educational procedure 1 Fig. 1 Concept of first action presented in the stroke lesson (originally presented in German)  The teaching session was presented by first aid instructors integrated in regular first aid training programmes of 8 to 16 hours duration of the St. John Ambulance all over Bavaria. A small booklet was made for the first aid instructors to provide more detailed information about stroke. Data collection and analysis To investigate the effect of the teaching, all participants of designated courses were asked to fill out a questionnaire before the stroke lesson. At the end of the training program a similar questionnaire was presented slightly altered in structure and some questions. The overall length of the training courses differed as some courses were presented on a whole day schedule within one weekend while others offered one 90-minute teaching unit once weekly and were therefore scattered over a period of up to 6 weeks. Accordingly the time delay between the stroke lesson and the post-teaching questionnaire varied as well ranging from 1 to 28 days (mean 8.6 d). Before teaching participants were asked to note in free text and explain what they think that a stroke is, to name signs and symptoms of stroke and to describe how they would act in case of witnessing stroke. Additionally sex, age and profession of participants was recorded as well as their previous information about stroke After the lesson we asked again for a definition of stroke and to list symptoms of stroke. Furthermore we asked how urgent they think that a stroke needs to get therapy. After all subjects were asked for their satisfaction with the training session, how they would rate their own interest in stroke and how they would rate the importance of stroke as a topic in first aid. Therefore a rating scale from 1 to 6 was given with 1 being the best, 6 the worst. Participants with any profession within health care were excluded from the analysis. The questionnaire was not offered in trainings for special groups such as in schools or nursing homes. Mean values were compared using paired t-tests while χ²- statistics were used for proportions of nominal data. Results In 38 first aid training courses 532 participants (86.6% of 614 subjects attending the training) completed the questionnaire before and after training, 53.6% of those were male, mean age was 28.6 years (+/− 11.1 y, range 15–61 y). Before training 28.4% of all participants stated a correct description of stroke, another 32.7% gave at least the brain as the location of the disease. The mean number of stroke symptoms named was 1.52 (± 1.1), descriptions listed were mainly “weakness”, “motor problems” “disturbance of consciousness” or “speech problems”, 12.8% of all respondents did not list at least one correct stroke symptom or warning sign, 40.7% listed symptoms that are not typically suggestive of stroke (coded as incorrect). The mean number of first aid measures named was 1.22 (± 1.0). 78.7% of respondents stated that they had any kind of information about stroke before the training. 1 Table 1 Key results from the questionnaire before and after receiving the stroke lesson n = 532 before stroke lesson after stroke lesson  mean number no. of stroke signs 1.52 3.35 p < 0.001 no. of first measures 1.22 not asked  % of participants correct explanation what stroke means  28.4 69.9 p < 0.001 brain affected organ 32.7 20.3 p < 0.01 no/incorrect explanation 38.9  9.8 p < 0.01 > 4 symptoms listed  2.6 28.4 p < 0.001  no symptom listed 12.8  3.6 p < 0.001 “immediate medical help required” not asked 58.5  prior information about stroke 78.7   Most participants were satisfied with the stroke lesson as the mean value in the score (1 = best to 6 = worst) was 1.76 (± 0.6), interest in topics of stroke was rated high (mean 1.56, ± 0,8). Stroke was regarded as an important topic for first aid training. (mean 1.57, ± 0,9). The difference in mean number of symptoms named before and after the lesson was highly significant (p < 0.001), as well as the difference in percentage of participants giving a correct definition of stroke (p < 0.001) and those naming more than 4 symptoms. In contrast the number of participants not listing at least one symptom and giving none or an incorrect definition of stroke was significantly reduced after the training. Discussion To our knowledge this is the first study published reporting about first aid training for public education on stroke. A teaching session was integrated in regular first aid training offered to the public by the St John Ambulance. From data of this pilot study the teaching session was very effective: Mean number of stroke symptoms and number of participants giving a correct description of stroke more than doubled. 9 10 11 12 3 6 8 None of these studies handled information on stroke integrated in general health education campaigns such as routine first aid training. From our viewpoint integrating a stroke lesson in first aid training is not only effective but provides a number of advantages. First an integration makes it clear that stroke or brain attack is an important medical emergency as important as heart attack or trauma. 13 14 15 8 16