Medical and emergency emblems

The Star of Life on ambulances

The Star of Life is a blue cross of six bars with a staff and snake in the centre. The National Highway Traffic Safety Administration (NHTSA) created it and holds it as a registered certification mark, registered on 1 February 1977. A certification mark, NHTSA explained in the Federal Register in 1994, is owned by one body and used by others, where a trade mark gives its owner the only right to use it. EMS.gov says each bar stands for one of six functions of an emergency medical services system: detection, reporting, response, on-scene care, care in transit and transfer to definitive care. It says the staff and snake are the staff of Asclepius, and the snake, which sheds its skin, stands for renewal. On maps and highway signs the star marks where emergency medical care can be reached.

NHTSA’s 1994 notice lists the uses it authorizes: on ambulances, on the patches and badges of EMS staff, on training materials, on equipment and supplies for emergency care, and on bracelets worn by patients to tell emergency medical care providers about a medical condition. Any other use, it says, is prohibited, and it reports attempts to put the star on furniture and car repair businesses.

Who designed it is disputed. EMS.gov says it was adapted from the American Medical Association’s medical identification symbol. Donnie Woodyard, Jr., writing on his EMS history site in 2023, says NHTSA first tried an orange cross on a white background; that the Secretary of Transportation’s office adopted the six-barred star for all federally funded ambulances on 26 September 1972; and that Leo R. Schwartz of NHTSA, often named as its designer, only added the six function labels. NHTSA’s own notice dates the Secretary’s approval of the star for the department’s EMS programme to a memorandum of 18 November 1976.

Medical alert symbols on IDs

A medical ID is there to give first responders and medical staff the wearer’s health information. The MedicAlert Foundation’s UK guide says the symbol on it signals at once that the wearer has vital health needs, so that responders turn the ID over to read it or call the helpline number on it. MedicAlert’s own jewellery carries the rod of Asclepius, one snake on a staff, and the guide says medical ID symbols are red because red is a high-visibility colour that signals an alert. The foundation traces its symbol to Dr Marion Collins, who had the idea for a medical alert system after his daughter Linda’s near-fatal allergic reaction. He and his wife Chrissie made the first MedicAlert bracelet, the foundation was incorporated in Turlock, California, in 1956, and Collins campaigned at his own expense for the symbol to be recognized worldwide.

The Star of Life appears on IDs too: bracelets worn by patients are one of the uses NHTSA authorizes. The MedicAlert guide names the usual look-alike. The caduceus, with two snakes crossing round a winged staff, is often mistaken for the rod of Asclepius.

The red cross, red crescent and red crystal

The International Committee of the Red Cross (ICRC) says the three emblems protect military medical services and relief workers in armed conflict, and describes two uses. The protective emblem is red on a white background with no additions, displayed large on protected buildings such as hospitals and on vehicles, and a deliberate attack on a person, equipment or a building bearing it is a war crime. The indicative emblem is mainly a peacetime use, comparatively small, by which national Red Cross and Red Crescent societies identify themselves, in effect as a logo. Each state party to the Geneva Conventions is required to pass laws on the emblems’ use and misuse.

The ICRC’s leaflet on misuse gives three examples of display that is not authorized: a health practitioner’s clinic, a pharmacy’s shopfront sign, and a company’s product or advertisement. Any sign whose shape and colour could be confused with the emblems counts as misuse too. In the United States, 18 U.S.C. § 706 makes it an offence for anyone other than the American National Red Cross and the armed forces’ sanitary and hospital authorities to use a red cross on a white ground, or an imitation of it, with a fine or up to six months in prison; uses that were lawful on 25 June 1948 are excepted.

The ICRC says the red cross on white was chosen as the exact reverse of the flag of neutral Switzerland. The Ottoman Empire adopted the red crescent during the Russo-Turkish war, Persia adopted a sign of its own, the red lion and sun, and in 1929 governments recognized all three. Iran dropped the lion and sun for the red crescent in 1980. In 1992 the ICRC’s president called for an emblem with no national, political or religious connotation, and in 2005 governments adopted the red crystal.