However, it takes about 15 minutes from starting the call to arrival of EMS on scene [12]. During this time a bystander should be able to offer help to the patient. By presenting simple hands-on measures it is also emphasized that something can and must be done in case of acute stroke. The effect of various educational interventions was already demonstrated in previous studies [3, 6–8]. None of these studies handled information on stroke integrated in general health education cam- paigns 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. Connecting brain attack with other medical emer- gencies also facilitates the demonstration of measures as they could be used for other situations as well and it might help to create a better understanding to stroke and its differences from other related diseases. We linked stroke to other related topics (e.g. ‘‘head trauma’’) and formed a cluster of measures for ‘‘all problems in the head’’ as an effort towards integrative problem-based teaching which was shown to be superior to conventional lessons also in medical education [13]. Second, by using ﬁrst aid training information on stroke this will reach large numbers of subjects not particularly interested in stroke or sometimes health education at all. According to their annual review the St. John Ambulance, England, issued a ﬁrst aid training certiﬁcate to more than 500000 people in the year 2003 [14], while the American Red Cross trained 1345 more than 11 million people in ﬁrst aid [15]. In Germany within one year a driving license is issued to more than 800000 people mainly in the age of 16 to 21. By legal regulations every one of them must have completed at least an 8 hour ﬁrst aid training. So ﬁrst aid training may especially reach younger people that are not interested in stroke awareness campaigns. Furthermore, given the large numbers of people reached, this method of education is extremely cheap. To summarize we found that a 15 minute presen- tation on stroke as a medical emergency improves stroke knowledge of participants in ﬁrst aid training. Furthermore participants seem to appreciate getting information about stroke. Accordingly information on stroke or brain attack should be included in every ﬁrst aid training thus reaching large numbers of subjects in many countries all over the world. Means of information may differ in their effectiveness [8, 16] but the question is not whether education integrated in training programs may be more effective than mass media campaigns. Both methods of information will rather be complementary as they use different ap- proaches and may reach different target groups. The goal is not to miss any single opportunity to send out the message about stroke as a medical emergency that needs immediate reaction by anyone who is next. j Acknowledgements We are grateful to all participants of the first aid training for their interest in helping people possibly involved in a medical emergency. We especially thank all volunteers and staff of the St. John Ambulance in Bavaria for making this project possible, in particular Ursula Ittner, Uwe Merklinger and Martin Steinkirchner. We also thank Marion Handschu-Dietrich for her support and advice in preparing the manuscript. References 1. 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