Star of Life

How to read it

NHTSA created the Star of Life and holds priority rights to it as a registered certification mark (EMS.gov); the Patent and Trademark Office issued the registration on 1 February 1977, No. 1,058,022. NHTSA describes each of the six bars as one EMS function: detection, reporting, response, on-scene care, care in transit, and transfer to definitive care. In its description the staff of Asclepius stands for medicine and healing, and the snake, which sheds its skin, for renewal; Asclepius was an ancient Greek physician deified as the god of medicine. On maps and highway signs the star marks the location of, or the way to, emergency medical care.

Also searched as: ambulance symbol, ems symbol, star of life, star of life emblem.

Who may use it

A certification mark is owned by one body and used by others to certify something, as NHTSA’s 1994 notice in the Federal Register explains. NHTSA’s criteria let states and federal agencies with an EMS role permit its use on ambulances that meet the federal ambulance specification or are authorized to respond to emergencies; to mark the location of and access to emergency medical care; on patches, badges and pins of trained and authorized EMS personnel and those who run EMS systems; on patient bracelets under a state or federal program; on EMS training materials and publications; and on medical equipment and supplies for EMS providers. The criteria say “any other use is prohibited”, and that the registration symbol ® must appear next to the star. NHTSA wrote in 1994 that it had acted against non-EMS uses, naming furniture and automobile repair businesses.

On ambulances

The US General Services Administration’s Federal Specification for the Star-of-Life Ambulance (revision F, 2007) lets the final-stage manufacturer use the star to identify an ambulance as meeting the federal specification. It calls for a blue star with a white border on each side of the word AMBULANCE on the front, one of at least 41 cm (16 inches) on each side panel, one on each rear door, and one of at least 81 cm (32 inches) on the roof, which may leave out the white staff of Aesculapius.

Who designed it

EMS.gov says the Star of Life was adapted from the American Medical Association’s medical identification symbol. Donnie Woodyard, Jr., writing on his EMS History site, traces the six-barred design to that AMA symbol of the early 1960s, which the World Medical Association adopted in Helsinki in 1964, and disputes the often repeated claim that NHTSA’s Leo R. Schwartz designed it in 1977: in his account Schwartz added the six function labels to a design already more than a decade old. Woodyard writes that NHTSA’s first ambulance symbol was an “Omaha Cross”, an orange cross on white, dropped because it imitated the red cross, and that the Department of Transportation adopted the Star of Life on 26 September 1972. NHTSA’s 1994 notice dates the Secretary of Transportation’s approval to a memorandum of 18 November 1976.

On medical ID bracelets

Since NHTSA’s 1994 amendment, states and federal agencies may permit the Star of Life on bracelets worn by patients to tell EMS providers about a medical condition or a treatment decision such as do not resuscitate. Bracelets of this kind are one form of medical ID.