Providing paramedics with more training and the ability to perform more advanced medical procedures could save 20,000 lives a year in North America, finds a new study conducted in Canada.

The Ontario Prehospital Advanced Life Support (OPALS) Study was a controlled clinical trial conducted in 15 cities before and after the implementation of a program to provide paramedics with advanced life support (ALS) training on how to help patients with out-of-hospital respiratory distress.

"If you want to save more lives, we need to provide advanced life measure to any patient having trouble breathing," lead author Dr. Ian Stiell, a senior scientist at the Ottawa Health Research Institute, and Emergency Department physician at the Ottawa Hospital, told CTV News.

The study looked at 8,138 Ontarians in 18 urban communities attended by paramedics for respiratory distress either before or after implementation of ALS training in Ontario in 1998. During the first phase, no patients were treated by paramedics trained in advanced life support; during the second phase, 56.6 per cent of patients received this treatment.

They found that patients in the ALS phase were more likely to arrive at the hospital in improved condition (45.8 per cent compared to 24.5 per cent); were more likely to achieve the highest score in a test of brain function (62.5 per cent compared to 52.3 per cent); and were more likely to survive overall.

"We found that training paramedics to provide advanced care to people in respiratory distress decreased the rate of death from 14.3 per cent to 12.4 per cent," said Stiell.

"Although this may seem like a small amount, when you consider that more than 2 million Canadians and Americans are transported by ambulance each year for this condition, the impact is substantial."

Stiell estimates that at least 2,000 Canadian lives would be saved if more paramedics across the country were trained in ALS.

The study also found that patients in cities with a population of more than 100,000 were more likely to benefit during the second phase of the trial.

The results of the study -- the largest of its kind - will be published Thursday in the prestigious New England Journal of Medicine.

One in every five ambulance calls is to help someone having trouble breathing. The most common causes of respiratory distress in this setting include congestive heart failure, pneumonia, chronic obstructive pulmonary disease, and asthma.

Paramedics with ALS training can insert breathing tubes and administer intravenous drugs -- treatments that are usually given in emergency rooms. Those without are limited to giving oxygen, and in some cases providing inhalers and medications that dissolve under the tongue, such as nitroglycerin.

Advanced Life Support (ALS) training for paramedics was introduced throughout Ontario in 1998, but plenty of paramedics still don't have the training. Some provinces have no advanced paramedics.

But as studies such as this one demonstrate how effective well-trained paramedics can be in saving lives, interest in ALS is growing. At the few colleges that offer the advanced training, there's usually a waiting list for the three-year training programs.

"There is a demand out there," said Dr. Josh Ip of the Paramedic Academy of the Justice Institute of B.C. "I would encourage people with an interest in pre-hospital care medicine to perhaps choose this as a career."

As well, more towns and cities are looking to hire ALS-trained paramedics. The City of Ottawa wants at least 50 to 60 per cent of its paramedics to have advanced training but has discovered they are a hot commodity.

"We're not able to have advanced care paramedics on every life threatening call because they're just not there. We're not able to attract or recruit them," says Anthony Di Monte of the Ottawa Paramedic Service.

"This study proves that advanced care paramedics can make an important difference for those suffering from life-threatening respiratory difficulties."

With a report from CTV medical specialist Avis Favaro and medical producer Elizabeth St. Philip