The Star of Life — The Profession's Symbol with a Misrepresented History
The Star of Life is a powerful visual reminder of the critical role that EMS practitioners play in saving lives and promoting public health. By serving as a unifying symbol for EMS professionals since the late 1960s, the Star of Life highlights the essential nature of the work and the significant impact EMS practitioners have on the well-being of individuals and communities they serve. The primary source documents referenced throughout this article are preserved and freely accessible in the EMS Document Library.
Untangling The History
The Star of Life has a rich, yet often misrepresented history. The original Star of Life was designed by the American Medical Association (AMA) in the early 1960s as the "Universal Medical Identification Symbol" (also known as the "Universal Emergency Medical Identification Symbol"). The original intent was for this symbol to be freely available and printed on cards carried by persons with any medical conditions such as diabetes or epilepsy. This universal symbol would be easily recognized by the public and medical professionals during an emergency. The AMA did not trademark or copyright the symbol, but freely provided it to manufacturers and the public for use. The AMA widely promoted the use of this "Universal Medical Identification Symbol" in its journal and in numerous governmental publications. (Read the original 1963 Star of Life design document.)
In 1964, the World Medical Association's Assembly in Helsinki, Finland, adopted the "Universal Emergency Medical Identification Symbol" for worldwide use, sponsored by the AMA. (See the 1964 Personal Emergency Identification System document.) Shortly after, in March 1966, the "Universal Emergency Medical Identification Symbol" was being referenced as the "Star of Life" by the Federal Bureau of Investigation and others.
In 1969, under the chairmanship of Irvin E. Henderson, MD, the AMA Commission on Emergency Medical Services encouraged the Department of Transportation to display the symbol on road signs to denote hospital Emergency Rooms. (Read the 1969 Public Health Report documenting the UMIS transition to the emergency medical symbol; see also the 1969 Public Health Bibliography on UMIS and EMT Training and the 1965 UMIS Star of Life document.) The next year, the AMA House of Delegates officially adopted the "Star of Life" design, which was the Universal Medical Identification Symbol without the surrounding hexagon.
Simultaneously, President Lyndon Johnson's Committee on Highway Traffic Safety formed a Task Force tasked with establishing a national EMS certification agency. The AMA led this Task Force, with many individuals who contributed to the creation and publication of the Universal Medical Identification symbol also appointed to the Task Force. The first meeting of this Task Force was on January 21, 1970, with additional representatives from the following organizations:
- Ambulance Association of America
- International Association of Fire Chiefs
- International Rescue and First Aid Association
- National Ambulance and Medical Services Association
- National Forest Service
- National Funeral Directors Association
- National Park Service
- National Safety Council
- National Ski Patrol
- American Heart Association
- International Association of Chiefs of Police
The Task Force moved quickly, and on June 4, 1970, the first meeting of the Board of Directors of the Registry of Emergency Medical Technicians (later renamed as the National Registry of Emergency Medical Technicians) was convened. (Read the AMA Task Force meeting minutes that led to the establishment of the NREMT.) Roddy A. Brandes, of the Ambulance Association of America, was elected the Board's first Chairman.
The new organization — and the new profession — needed a symbol. What it received was far more than a graphic design.
The American Medical Association in 1970 was not merely a professional association. It was the most powerful institutional authority in global medicine: the gatekeeper of who could practice, what could be taught, and which professions would be recognized as legitimate within the medical establishment. The AMA had already branded its Universal Medical Identification Symbol worldwide, securing its adoption by the World Medical Association in Helsinki in 1964, and its recognition by the FBI, the Department of Transportation, and international health agencies. The symbol carried the full institutional weight of organized medicine.
The AMA was doing something unprecedented with EMS. It was creating an entirely new category of medical professional: non-physicians who would start intravenous lines, intubate airways, interpret cardiac rhythms, and administer medications in the field. This was a scope of practice and clinical autonomy that simply did not exist outside of physician practice. The resistance from within healthcare was real. Nursing organizations and allied health professions questioned why ambulance personnel should be permitted to perform procedures that their own practitioners had fought for decades to secure. The AMA overrode those objections. It created the EMT-Basic, and then recognized the EMT-Paramedic through the same allied health accreditation pathway it controlled. The AMA staked its brand and institutional credibility on the legitimacy of this new profession.
When the AMA transferred its Universal Medical Identification Symbol to the Registry of EMTs, it was not donating a logo. It was conferring institutional protection. The Star of Life on an EMT's patch meant that this provider, and this profession, operated under the explicit endorsement and authority of the most powerful body of organized medicine on the planet: the American Medical Association.
In 1971, the first 1,520 ambulance personnel took the first standardized national EMS certification examination at fifty-one testing locations across the United States. The successful candidates received a patch bearing that symbol: a direct connection to the brand, the authority, and the institutional protection of the most powerful medical organization in the world, signifying both demonstrated competence and adherence to a unified national standard.
Critically, in the early 1970s, the Star of Life was a protected symbol — only NREMT-certified EMTs were permitted to wear it. It was not a generic logo to be used freely; it carried the weight of demonstrated professional competence and a direct lineage to the American Medical Association.
The 1971 Registry of EMTs National EMT-Ambulance Patch, featuring the Star of Life
The original 1971 trademark of the Registry of Emergency Medical Technicians, incorporating the Star of Life.
On April 12, 1973, the Registry of EMTs trademarked the Registered Emergency Medical Technician symbol that clearly incorporated the Star of Life. (View the NREMT Star of Life trademark documentation; see also the complete Star of Life history and the Emergency Medical Care Symbol documentation.) Honoring the work of the visionary physicians of the American Medical Association—that fought for a new medical profession and gifted the profession a unique symbol—the Star of Life has been incorporated into every National EMS Certification card and patch earned for over fifty years.
A Geneva Convention Violation?
It's 1972 and ambulance services are being established at a record pace in communities across the nation. Thousands of personnel are being trained as EMTs, and the nation is being entertained and educated by the new hit show, "Emergency!". However, there's a growing two-fold problem that is rapidly getting out of control: NHTSA's first attempt at a standardized symbol for the emerging profession was an Omaha Cross, which was an orange Greek Cross on a white background, and secondly many community ambulance services were using the actual Red Cross logo on ambulances.
Circa 1950s Post Card Ambulance
However, NHTSA encountered serious issues with the Omaha Cross (the orange Greek Cross). In a 1974 NHTSA publication they acknowledged the problem:
"a cross of reflectorized Omaha orange on a square background of reflectorized white might violate a Congressional grant to the Red Cross of 'the right to have and to use ... as an emblem and badge, a Greek Red Cross on a white background, as the same has been treated in the treaties of Geneva'…the orange cross specified by the National Highway Traffic Safety Administration (NHTSA) clearly is a 'colorable imitation' of the Geneva Red Cross".
Meanwhile, the AMA and ACEP were moving forward promoting the Star of Life as the standardized symbol for Emergency Medical Services (including the newly standardized hospital emergency department concept). (Read the ACEP position paper from 1972 in the Document Library.)
Recognizing this emerging concern that further use of the Omaha Cross or the Red Cross is restricted by both the U.S. Congress and the Geneva Convention, Dr. Dawson Mills, the Chief of the EMS Branch for the National Highway Traffic Safety Administration, had to find an alternative symbol for ambulances quickly.
Dr. Mills was very involved with the Task Force that formed the National Registry of EMTs and he knew the AMA had gifted the Star of Life as the symbol for the NREMT. So, he raised this urgent concern to the organization's multidisciplinary board. Recognizing the Universal Medical Identification Symbol was quickly gaining recognition and acceptance, he requested permission to extend the use of the Star of Life symbol as the "national identifier for Emergency Medical Services" that would be used on all ambulances. (Subsequently, the federal ambulance standard was later known as a "Star of Life Ambulance".) The Registry's board agreed and approved this request, and Dr. J.D. Farrington, as Chair of Board, memorialized this in a memo to Dr. Mills.
While the Registry of EMTs would continue to use the symbol, the Department of Transportation expanded the use of the blue 'Star of Life' and mandated its use on all ambulances purchased with federal funds. On September 26, 1972, the Office of the Secretary of Transportation issued a Memorandum adopting and recognizing the "Star of Life". (Read the 1972 Star of Life design and adoption documentation.) By 1975, Leo R. Schwartz, the new Chief of the EMS Branch at NHTSA, modified the Star of Life by adding the six main tasks associated with EMS.
In 1974, the Department of Transportation noted (in the Highway Safety Program Manual):
"It has been concluded by NHTSA that it is proper not to further interfere with the organizational identification provided by the Greek Red Cross. Rather, it is considered preferable to adopt a separate symbol which clearly and distinctively identifies the emergency care vehicle or ambulance within the total spectrum of the Emergency Medical Care system. The 'Star of Life' has already been identified by the medical profession as a medical emergency symbol and its highway related use encouraged by the American Medical Association."
On February 1, 1977, the "Star of Life" was issued Registration Number 1058022 by the United States Patent and Trademark Office in the name of the Department of Transportation's National Highway Traffic Safety and Administration.
NHTSA Star of Life Brochure
NHTSA's 1979 brochure promoting the Star of Life includes an "abbreviated" history of the Star of Life noting that the Star of Life in the "specific configuration" was designed by Leo Schwartz (notably, Leo Schwartz was the Chief of NHTSA's EMS division). The "specific configuration" was not the actual Star of Life, but the addition of the six system functions of EMS attached to the six points of the Star of Life. (Read the 1979 NHTSA Star of Life brochure — the source of the erroneous design claim.)
Regardless of the lost history, the Star of Life holds immense significance within the EMS profession, serving as a powerful reminder of both its origins with the AMA's pioneering physicians balanced with the reminder that facts and history can quickly fade into oblivion. The Star of Life emerged as a unifying symbol, aiming to bring together a fragmented profession and instill public confidence by signifying that every ambulance, EMT, or Paramedic adorned with the Star of Life had successfully met the unified national standard. As EMS again undergoes a new process of reunification, the Star of Life will hopefully symbolize integration and a renewed linkage with the healthcare system.
Key Facts: The True Origin of the Star of Life
- Who designed the Star of Life?
- The Star of Life was designed by the American Medical Association (AMA) in the early 1960s as the "Universal Medical Identification Symbol." It was not designed by Leo R. Schwartz of NHTSA in 1977, as commonly but incorrectly stated across the internet and in many EMS publications. Schwartz added the six EMS system function labels to the existing symbol's points, but the six-barred cross design itself predates his involvement by over a decade. (1963 original design document)
- When was the Star of Life created?
- The symbol was created by the AMA in 1963 and published in the Journal of the American Medical Association (JAMA, Vol. 186, No. 1, p. 56). In 1964, the World Medical Association adopted it at its assembly in Helsinki, Finland, as the "Universal Emergency Medical Identification Symbol" for worldwide use. By 1965, it was being connected to emergency medical services for aging populations (1965 UMIS document), and by 1966, the FBI was already referring to it as the "Star of Life."
- How did the Star of Life become the EMS symbol?
- In 1970, when the AMA's Task Force formed the National Registry of Emergency Medical Technicians (NREMT), the AMA transferred the symbol to the Registry to designate nationally certified EMS personnel (AMA Task Force minutes). In 1971, the first 1,520 nationally certified EMTs received patches featuring the Star of Life. The NREMT trademarked the symbol on April 12, 1973 (NREMT trademark documentation). Separately, Dr. Dawson Mills of NHTSA requested and received permission from the NREMT board to extend the symbol's use to all federally funded ambulances, and the DOT Secretary's office adopted it on September 26, 1972 (1972 adoption documentation).
- Was the Star of Life a protected symbol?
- Yes. In the early 1970s, only NREMT-certified EMTs were permitted to wear the Star of Life. It was a protected symbol signifying that the wearer had passed the national standardized certification examination and met the unified professional standard established by the AMA and NREMT. It was not a generic logo — it carried the weight of demonstrated competence and a direct lineage to the American Medical Association.
- What did Leo Schwartz actually do?
- Leo R. Schwartz became Chief of the EMS Branch at NHTSA after the symbol had already been adopted. By 1975, he added the six EMS system function descriptions (Detection, Reporting, Response, On Scene Care, Care in Transit, Transfer to Definitive Care) to the six points of the existing Star of Life. In NHTSA's 1979 brochure, Schwartz claimed credit for designing the symbol in its "specific configuration" — a claim that effectively wrote himself into history and erased the AMA's role and the NREMT's prior use. (Read the 1979 NHTSA brochure containing the erroneous claim.)
- What primary sources document this history?
- Nine primary source documents in the EMS Document Library trace the complete history: the 1963 AMA original design, the 1965 UMIS document, the 1969 Public Health Reports on UMIS transition, the 1969 Public Health Bibliography, the 1970 AMA Task Force minutes, the 1972 DOT adoption documentation, the 1973 NREMT trademark, the complete Star of Life history, and the 1979 NHTSA brochure. The 1963 JAMA article, the 1966 FBI Law Enforcement Bulletin, and USPTO trademark filings (serial number 72454410, registration 1020230) all predate any involvement by Leo Schwartz.
References
- American Medical Association. (1963). Universal Medical Identification Symbol. Journal of the American Medical Association, 186(1), 56.
- Universal Medical Identification Symbol. Am J Dis Child. 1964;107(5):439.
- FBI Law Enforcement Bulletin. (1966). United States: Federal Bureau of Investigation, U.S. Department of Justice.
- Wiegenstein, J. G. (1972). AMA star of life needs to be recognized. Journal of the American College of Emergency Physicians, 1(3), 15-17.
- Becker, L. R. (1991). An EMS history primer. St. Louis, MO: Mosby Lifeline.
- United States Patent and Trademark Office, serial number 72454410 and registration number 1020230.
- United States Department of Transportation. (1974). Highway Safety Program Manual Number II (p. IV-61).
- Emergency Medical Services. (1974). United States: The Administration.