Abstract Background Bulgaria had the highest road mortality rate among European Union members in 2023, having previously ranked second after Romania. Research has consistently demonstrated that prompt pre-hospital care can significantly reduce the adverse effects of road traffic accidents. Thus, we conducted a cross-sectional study to explore the involvement of trained road traffic casualties and bystanders in administering first aid. Methods The study, carried out between April and December 2021, collected data via an online survey administered to members of the Scientific and Academic Cooperation Council by the State Agency Road Safety. The survey encompassed a range of topics, including first aid training, involvement in traffic accidents, behaviour of bystanders, administration of first aid, and sociodemographics. Results Among the 292 respondents, a sizeable proportion (90%) reported having received first aid training. Of these, 35.1% (95% CI 29.2-41.1%; p < 0.001) had personally experienced a road traffic accident, and 64.5% (95% CI 58.1-70.1%; p < 0.001) had witnessed one. It is noteworthy that a fifth of those involved in accidents had employed the skills acquired from first aid training, which included applying a dressing to a wound, bleeding control, and immobilising a fracture. Correspondingly, an equivalent percentage of bystanders administrated aid, with the majority of them performing basic airway management. However, the findings revealed that a significant proportion of participants (79.3%) did not engage in providing first aid. The primary rationale stated was the assessment that it was nonessential. Conclusions Despite the growing road safety challenges and many respondents witnessing or being involved in accidents, only a quarter of those trained in first aid actually provided assistance. Considering the increasing number of deaths and severe injuries, it is crucial to assess the need for frequent first aid training and the population’s proficiency in first aid. Key messages • Bystanders’ competence in administrating first aid can mitigate the adverse effects of road traffic accidents. • Among other road safety measures, investments in first aid training can be beneficial in reducing fatalities and severe injuries.