programmess differing in length and depth of infor- mation. First aid training was effectively used to teach the public in new methods of life-saving therapy like automated external deﬁbrillation [1]. Stroke or brain attack is not or only marginally included in ﬁrst aid training. This is in contrast to the fact that management of acute stroke changed as it is now handled as a high priority emergency [2]. Lim- ited knowledge of signs, symptoms and risk factors for stroke was noted as an important factor associated with delay of admission [3–5]. To enhance awareness on stroke, various educational programmess have been initiated [3, 6–8]. The American Stroke Associ- ation’s Operation Stroke, a huge awareness campaign on stroke, the Coordinated Stroke Programme of Southwestern Ontario and King County’s Medic One at seattle are examples of continuous health education programmes using internet, designated courses and mass media. Regular ﬁrst aid training was never used in a stroke information campaign though it is widely available and well accepted in many countries. 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 j Educational procedure A teaching sequence was created by stroke neurologists of the University of Erlangen together with senior instructors of the St. John Ambulance (Johanniter-Unfall-Hilfe) in Bavaria. Educational Fig. 1 Concept of first action presented in the stroke lesson (originally presented in German) 1343 objectives of the session were clearly deﬁned. The sequence was designed for a 15 to 20 minutes audiovisual presentation and provided information basically what stroke means and about stroke risk factors, warning signs and symptoms. Warning signs presented included sudden uni- or bilateral weakness or numbness, facial paresis, speech disturbance, blurred vision, trouble in walking, vertigo/ dizziness, diplopia. Then a concept of ﬁrst action to be taken in case of stroke was presented (Figure 1 shows a one-slide overview). including check of vital signs and immediate activation of EMS. 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. j Data collection and analysis To investigate the effect of the teaching, all participants of desig- nated courses were asked to ﬁll out a questionnaire before the stroke lesson. At the end of the training program a similar ques- tionnaire 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 symp- toms of stroke and to describe how they would act in case of wit- nessing 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 impor- tance 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.