Early first aid interventions are key elements of the Systems Saving Lives framework, with two major pillars being Kids Save Lives and dispatcher-assisted guidance. Both strategies remain understudied in very young children, particularly in situations other than cardiac arrest. This study aimed to evaluate whether 6–8-year-old children, working in pairs, can recognize an unconscious adult and initiate appropriate first aid when supported by structured education and/or real-time video-assisted dispatcher guidance.

We conducted a quasi-experimental simulation study involving 110 first-grade children (aged 6–8 years) from two Hungarian schools. Participants were allocated to: (1) structured first aid training plus video-guidance, (2) video-guidance only, or (3) no preparatory training. During simulations, each pair encountered an adult actor simulating collapse and, where applicable, received video guidance from a trained dispatcher. Performance was evaluated using a nine-step checklist based on international guidelines, assessing recognition of unresponsiveness and management of the recovery position.

Children who received both training and video assistance performed significantly better in task accuracy (mean score 7.5 vs. 4.6 vs. 0.5; all p < 0.001), completion time (229.5 vs. 394.1 s; p = 0.002), and full task success (61.1 % vs. 10.5 % vs. 0 %) compared with the video-guidance only and the no training groups.

In this simulation setting, 6–8-year-old children working in pairs could recognize an unconscious adult and initiate first aid when supported by prior training combined with video guidance. Digital assistance alone was insufficient, suggesting that video-guided dispatcher support can enhance – but not replace - structured early first aid education.