Accidents and situations of danger caused by sudden deteriorations in health are part of everyone´s life. The system of emergency care, which was drawn up in the 1960s, emphasizes the role of the "inexpert rescuer” (1). Former studies confirm that with adequate first aid intervention the number of sudden deaths can be decreased significantly (2). Several studies highlight, however, that adults´ willingness to give first-aid is rather low (3).

A highly important field of first aid instruction is the development of children´s and adolescents´ competence. Numerous studies aim to prove that children and adolescents can also acquire a number of lifesaving techniques, such as CPR (cardiopulmonary resuscitation) and other first aid techniques (4, 6). These studies for several reasons consider the instruction of first aid to the above-mentioned age groups highly important. They point out the effect of prevention through the recognition of situations of danger, the development of a helping mentality, the development of the personality and the opportunity for repetition in learning. Giving first aid demands not only knowledge but also a positive emotional attitude and motivation.

The number of studies on the motivational components of first aid, however, is rather small (5) and that of studies on attitude to first aid is even smaller. A person´s attitude depends on several different factors, such as cultural background and education.

The present study is a comparative analysis of German and Hungarian children´s/adolescents´ knowledge of and attitude to first aid and highlights the differences which emerge from their different historical and educational backgrounds.

The research was carried out between February 2004 and February 2005 with the involvement of volunteers. The questionnaires were filled in by a high number of students aged 10-18. The questionnaire contained 20 questions which examined the general components of attitude towards first aid, the attitude to learning and the respondents´ current knowledge. The volunteers answered the questions individually. Multiple answers could be given to each question. In some cases the respondent had the opportunity to express his or her personal opinion and opinions were classified during processing. Sorting out German respondents was organised by the Hannover Johannita School in the province, in Hungary by the Semmelweis University, Faculty of Health Sciences in the Central Hungarian region. The statistical analysis of the answers required that the demographic data be analysed with a descriptive method, and the questions on attitude and learning with a cross-table examination.

Relations were assessed with the Pearson Chi-Square test (p<0.05). The questions examining current knowledge, after ranking the answers from a professional point of view, were evaluated by the Mann-Whitney non-parametric test.

1342 respondents´ questionnaires could be evaluated, of whom 711 were German and 631 Hungarian students.

59.7% of the German and 42.1% of the Hungarian respondents had previously received some sort of first aid instruction. 46% of German students stated school, 5.3% special lessons and 4.6% the ambulance services as the scenario of their first aid studies. 31.1% of Hungarian students were given first aid instruction at school and 8.7% in special lessons. They could not receive first aid training at any other places. 32% of German and 19% of Hungarian students confirmed that they had needed to use their first aid knowledge before. A significantly higher proportion of German respondents (Hungarian: 76.4%; German: 87.1%) said they would give first aid to any person (p=0.0003). 9.2% of Hungarian respondents said they would not give first aid to anybody, while none of the German students gave a similar answer.

A significantly higher proportion of Hungarian respondents confirmed that the lack of knowledge and repugnance to "strange materials” (e.g. blood) restrain them from giving first aid, whereas a higher proportion of German students declared that the main factor to hold them back from giving first aid is indisposition to personal action (p=0.0002).

Speaking about fear of first aid, a higher number of Hungarian students reported to be afraid of giving harm to the person in need (p=0.000). A roughly similar proportion of the two groups (10%) considered fearful the probability of contagion during first aid. Thus, a high number of both German and Hungarian students (German: 88.7%, Hungarian: 85.7%) agreed that learning first aid is of special importance. Hungarian students, however, did not mention any particular expectations, whereas German students would expect to get lessons on theory as well as practice (p<0.001). 9.8% of Hungarian and 6.7% of German students would not study first aid techniques at all. The two groups had a different opinion on the suitable age for learning first aid:

a significantly higher proportion of Hungarian students (Hungarian: 56.4%; German: 25.4%) believe that first aid can be taught at primary school, while German respondents argue that secondary education is the suitable scenario of first aid training (p<0.001). In neither of the two groups did the proportion of respondents claiming that first aid should be taught in kindergarten or higher education achieve 10%. 68.8% of German and 47.6% of Hungarian students would prefer to study first aid during school time (p<0.001). Hungarian students opt for learning first aid at special lessons or outside of school.

German students consider schoolteachers half as ready for teaching first aid as their Hungarian fellows (Hungarian: 14.3%; German: 7.5%). Both groups underline that the first aid instructor should also have proper teaching abilities (Hungarian: 85.5%; German: 92.4%).

German students opted for biology and P.E. lessons as subjects in the syllabuses of which first aid should be included, whereas Hungarian students chose health sciences. A higher number of German respondents considered a single course book satisfactory for learning, whereas Hungarian students required further complementary materials, e.g. video/CD recordings (p<0.001).

Two particular questions on first aid (traffic accident, fraction of the clavicle) were given significantly more correct answers by German, the other two by Hungarian students.

In order to reveal all the factors that lead to the results obtained, we compared all the data from three different aspects.

Regarding the location of the traffic accident, German students gave a higher number of correct answers in every comparison and the difference was conspicuous also among students who had not studied first aid before (p<0.001). Concerning intensive bleeding, however, Hungarian students gave significantly more correct answers (p<0.001), but there was no significant discrepancy among the answers received from girls, 15-16-year-old respondents and respondents who had not received first aid instruction before. In the case of a bleeding nose Hungarian students gave a higher number of correct answers (p=0.016). Boys and students with former instruction also proved to be more successful in responding. Regarding fraction of the clavicle, though, the German respondents answered better, with the exception of two subgroups.

Although both countries are members of the European Union, their historical and economic backgrounds and systems of education are rather different. In Hungary the socialist political regime and economic and educational system ended at the beginning of the 1990s. In comparison, the German area covered by the present research was not affected by a similarly profound social change. However different the history of the two countries proves to be, there is a long tradition of teaching first aid to inexpert people in both of them. One of the differences in their history of first aid training is that the German region, as a part of West Germany, experienced a roughly dynamic process of development. Thus in Hungary, teaching first aid at schools was abolished in the 1950s and it was only given ground again in the 1990s. Instruction, however, is rather sporadic, as every single school has the right to decide if they include first aid in the syllabus or not. This also explains why a higher proportion of German students took first aid studies. Moreover, in Germany training courses are also organised by the ambulance services, while this is not so in Hungary. It can be assumed that the political and economic development and, as a consequence, that of education causes that German students´ answers show a positive attitude which, in a significant number of students, is combined with motivation. Psychological studies verify that giving a hand in emergency medical situations is a basic form of altruistic behaviour (8). The outstanding rate of willingness to help (German: 87.1%, Hungarian: 76.4%) contradicts everyday experience and other surveys. Former studies report an average willingness of 20-30% (9). The high percentage may originate in the fact that the written test had no practical consequences and also in the desire to meet social expectations (10). It is conspicuous that almost 10% of Hungarian respondents said they would refuse to give first aid whereas none of the German respondents did so.

Numerous experts explain fears of first aid by the startling effect of defective teaching methods. Instructors´ efficient pedagogical work, however, can reduce the passivity resulting from fear and turn it into active behaviour. The willingness to give first aid can decline in proportion with the level of the task (e.g. resuscitation). Thus, several programmes verify that CPR and the use of a semi-automated defibrillator can be taught to school-age children. (11)

A similarly high number of both German and Hungarian students think that learning first aid has to be particularly important for everyone. German students, though, show a more positive attitude to learning. Hungarian students proved to be more indifferent about learning and there was a higher number of those refusing to learn. German students´ higher demand for the acquisition of both theory and practice suggests a higher level of determination. Further lapses appeared when choosing the proper age-groups. The answers were not influenced by gender and age. With the development of cognitive capacities primary school can be suitable for learning first aid (12), though it may be easier in secondary school when the students have already acquired all the necessary background knowledge.

Hungarian students seem to be more rejective to school. Consequently, they show a low willingness to study first aid at school. At the same time, they accept school teachers as first aid instructors more than their German fellows.

German students opted for biology and P.E. as the most proper subjects for teaching first aid. Several studies give accounts on the experience of teaching first aid in the combination of several subjects. (13) In Hungary a new subject, health sciences, was separated from biology, so Hungarian students can acquire first aid techniques in the framework of both subjects.

The answers given to specific first aid questions show equalization: some of the questions were answered typically better by Hungarian, others by German respondents. The course books used in the two countries, however, describe the techniques identically. (14, 15) The differences may result from didactic and conceptional discrepancies or possibly mistakes.

It is conspicuous that German students lacking first aid instruction answered a higher number of questions well. The result suggests that with a "hidden syllabus” German students come across more information from the surrounding environment.

Our intention with the questionnaire was to investigate German and Hungarian students´ opinions on first aid. From this comparative analysis the following conclusion can be clearly declared:

1. The analysis clearly reflects that German students have a more positive attitude to first aid. Moreover, they have a wider range of options where they can get proper training and they appear to be more motivated.

2. The importance of teaching first aid is nevertheless reinforced by the result that both German and Hungarian students familiar with first aid gave a higher number of correct answers than their inexpert fellows.

3. What might be in the background of the results needs further investigations.