Background: The management of a difficult airway requires training in cricothyroidotomy (CT). The objectives of this study were: (i) to describe technical changes made to The REAL CRIC Trainer model in order to increase its realism, (ii) to assess the model by experts in comparison to a commercial dry model, (iii) to evaluate its performance in a realistic simulation scenario for training technical and behavioural skills, and (iv) to assess whether the model can help to identify anatomic structures by ultrasound (US). Methods: An observational prospective study was conducted in which an assembled modified model was assessed by five experts in CT and comparing it with a commercial dry model. The fidelity of US images obtained in the model was compared to those obtained from volunteers. The usefulness and realism of the model, attached to a high-fidelity simulator's neck in emergent CT clinical scenario, was assessed by the 11 ICU staff taking part. Results: Using a score out of 10, CT performance in our model and in a dry model was rated by the experts as 9 vs. 6, respectively in external appearance, 8.4 vs. 5.8 in tactile fidelity, and 8.6 vs. 4.1 in technical realism. Participants in the simulation gave a mean score of 7.7/10 to the fidelity parameters. Usefulness for training of the model integration into a simulation scenario was rated as 9.6. Ultrasound images were evaluated as high fidelity. Conclusions: Our modified REAL CRIC Trainer model was rated high by experts in CT and participants in a simulated clinical scenario, and may be useful for a complete emergent CT training closer to the clinical reality than the models currently available.