Objective: To build the evidence base for first aid education by testing the hypothesis that learners will be more confident and willing to act in an emergency if their first aid education has attempted to break down perceived barriers to helping. Design: Additional activities were appended to and delivered alongside a control curriculum consisting of the Canadian Red Cross' Emergency First Aid training for adult learners. Both control and test learners completed questionnaires before, immediately after and at 6 months following their training. Setting: Four Canadian provinces: British Columbia, Alberta, Manitoba and Nova Scotia. Participants: A total of 199 adult participants elected to take part in the first aid training and were randomised into test and control groups. Methods: Following first aid training lasting 6.5-8 hours, we assessed learners' self-rated confidence/self-efficacy, willingness to act and changes in pre-identified fears and attitudes. Results: Learners from both control and test courses showed a positive change in self-efficacy and willingness to act although there was no statistically significant difference between control and test groups. The test course had a statistically significantly higher percentage of learners who were more aware of the bystander effect post learning. There was significant heterogeneity in learner outcomes which varied by Canadian province. Conclusion: First aid education can increase the propensity of learners to act. Although the additional activities provided in this study did not make a statistically significant difference to confidence and willingness to act, they may increase awareness of helping behaviours. Heterogeneity between Canadian provinces may link to differing provincial laws which protect lay people who try to help in an emergency.