Background. To date, no clinical trial has compared the paramedic placement success rates of two different video laryngoscope (VL) systems in a nonsimulation setting. Methods. This institutional review board–approved, multiagency, prospective, prehospital, nonrandomized, crossover trial compared the success rates and complications for two VL systems (Storz CMAC R , Macintosh #4 blade; King VISIONTM, Size 3). The providers completed initial didactic and hands-on training, were grouped by agency into two treatment arms based on call volume, and were randomly assigned the initial treating VL system. Patient inclusion criteria were: 1) > 18 years old, 2) required advanced airway management per standardized patient care guidelines, and 3) treating provider was trained in the use of VL. Patients with supraglottic airway placement prior to arrival were excluded. After six months of telephone data collection (available 24 hours a day/seven days a week) following a placement attempt, the VL systems were crossed over for the remaining four months. Patient (age, gender, body mass index [BMI], race, ethnicity, primary impression, call type, and difficult airway) and provider (age, gender, years of experience, >1 VL placement during the study period, agency, and phase) demographics were compared between groups. Overall success rates (successful placement/number of patients), success rates by attempt (successful placement/total number of attempts), and complications were compared between treatment groups using exact logistic regression. The Cormack-Lehane (CL) score for each attempt was also analyzed for impact on success rates using a generalized linear mixed-effects model. Results. Between October 2011 and August 2012, a total of 97 patients were treated by 55 of 186 (30%) trained providers. There were no differences in patient or provider demographics between groups. The overall success rate was significantly higher for the CMAC group (79% vs. 53%, odds ratio [OR] = 3.39; p = 0.008), as was the success by attempt rate (58.4% vs. 32.8%, OR = 2.88; p = 0.004). The provider-reported rates and absolute numbers of complications were similar between treatment groups (p = 0.16; p = 0.12). The most frequent complication reported was vomiting during insertion (7.2%). Higher CL scores predicted lower odds of success (OR = 0.379, p < 0.0001). Conclusions. Airway management with the CMAC resulted in a significantly higher success rate, although the rate is similar to previously published ETI success rates.