Little is known about the proficiency of prehospital personnel when performing cricothyrotomies. The authors compared two techniques for establishing an airway through the cricothyroid membrane used by paramedic students. One technique used a prepackaged kit that consisted of a dilator that is passed percutaneously through a breakaway needle. This percutaneous device (PD) was compared with a standard surgical approach (SA) using a scalpel and endotracheal tube. Data was collected on a total of 44 paramedic students who were allowed to attempt each of the procedures. No significant difference in the success rate on the first attempt was found between the two procedures (86% for the SA and 73% for the PD; P = .186). The surgical approach was significantly faster (46 +/- 17 seconds v 103 +/- 62 seconds; P < .01). It was also judged to be significantly easier to perform when evaluated on a linear analog scale (SA, 2.6 +/- 2.0 v PD, 5.1 +/- 2.8; P < .001). Because some procedures were performed on cadavers whose cricothyroid membranes had already been violated, the procedures performed on intact membranes only were also analyzed. Similar, statistically significant differences for insertion time and ease of insertion were again found. Prehospital personnel can be trained to perform cricothyrotomies with a reasonable degree of proficiency. A traditional surgical approach, however, may be faster and less difficult to perform than a comparable procedure using a commercially available percutaneous device.