Star of Life
The Star of Life is a symbol used to identify emergency medical services. It features a blue six-pointed star outlined by a white border. The middle contains a Rod of Asclepius – an ancient symbol of medicine. The Star of Life can be found on ambulances, medical personnel uniforms, and other objects associated with emergency medicine or first aid. Elevators marked with the symbol indicate the lift is large enough to hold a stretcher. Medical bracelets sometimes use the symbol to indicate one has a medical condition that emergency services should be aware of. The Star of  Life is widely used around the world, but like many international symbols, it has not been adopted everywhere. Its use is restricted to authorized personnel in some countries. History. The Star of Life originated in the United States. Previously, ambulances in the country commonly displayed a safety orange-colored cross on a square background. This was only a slight variation from the red Greek cross (✚) used by the International Red Cross and Red Crescent Movement. In 1963, the American Medical Association (AMA) designed the Star of Life as a "universal" symbol for medical identification. The AMA did not trademark  or copyright the symbol, stating it was being "freely offered" to manufacturers, and also was for use on cards carried by persons with a medical condition. By way of a 1964 resolution, it was adopted by the World Medical Association "as the universal emergency medical information symbol" The Star of Life was promoted by the American Red Cross and rapidly adopted worldwide. In 1970, when the American Medical Association's Committee on Emergency Medical Services formed the National Registry of Emergency Medical Technicians (NREMT), the AMA chose the Star of Life to designate nationally certified Emergency Medical Services personnel. In  1973, the NREMT filed for a trademark for the Star of Life logo, under the category of a collective membership mark. This version featured a Star of Life enveloped by a circle. NREMT's trademark was granted in 1975, but "was not renewed and therefore has expired." NREMT subsequently registered a service mark featuring a Star of Life and the words "NATIONAL REGISTRY." This logo's trademark remains active. In 1973, the American Red Cross complained that the traditional orange cross too closely resembled their logo of a red cross on a white background, the usage of which is restricted  by the Geneva Conventions. Dr. Dawson Mills, Chief of the EMS Branch, National Highway Traffic Safety Administration in the United States, asked the National Registry of EMTs for permission to use the star as the "national identifier for Emergency Medical Services" in the United States," and in 1977 reported to Congress that it had become the national standard. Leo R. Schwartz, Chief of the EMS Branch, National Highway Traffic Safety Administration in the United States, modified the Star of Life by adding the six main tasks of Emergency Medical Services and changing the color to blue. The "blue Star of  Life" was recommended for adoption by the United States Department of Health, Education and Welfare on October 25, 1973, and was registered as a certification mark on February 1, 1977 in the name of the National Highway Traffic Safety Administration. Both NREMT's version and the US government's modification omit the white outline around the edge common on many of today's ambulances. The US government's registration lists uses of the Star of Life, including "emergency medical care" and "emergency medical care vehicles." The US government's registration does not list any international classes of trademark. Federal standards  dictate requirements ambulances in the US must satisfy in order to display the Star of Life. The federal government has given states additional authority to manage the symbol. Private ambulance operators like AMR have trademarked logos featuring an embedded Star of Life. Symbolism. The six branches of the star represent the six main tasks executed by rescuers all through the emergency chain: Global usage. Asia. Vehicles of the Hong Kong Fire Services display the Star of Life. The symbol is also widely used in mainland China, Japan, and Singapore. It is less common in South Korea, where ambulances display a  green cross and green lights. Central and South America. The Star of Life is used in many Spanish speaking nations, where it is known as "La Estrella De La Vida." In Argentina, (SAME), the capital district ambulance service, uses a green and slightly rounded version of the Star of Life in their logo. In Brazil, the Star of Life is incorporated into the national emergency service's visual identity standards. Brazil's ABNT Standard NBR 14561 for ambulance design makes direct reference to being based on the American Star of Life vehicle. Ambulances which do not comply with the Brazilian  standard are prohibited from displaying the Star of Life or the word “RESGATE” (rescue). Australia and New Zealand. A few patient transport providers like Ambulance Service Australia use the Star of Life. However, it is far more common to see the Maltese Cross in this region. European Union. European Union ambulance design standard CEN 1789 section A1 "Recognition and Visibility of Ambulances" states:With the exception of Red Cross societies or where the "Star of life" is locally registered, a blue reflective "Star of life" emblem (minimum size 500 mm) together with reflective letters, numerals or a symbol identifying the  organization and the vehicle, should be applied to the roof of the ambulance...a blue reflective "Star of life" emblem should [also] be applied to the sides and rear of the ambulance.In Portugal, the Star of Life is referred to by the Portuguese name “Estrela Da Vida.” In March 1977, the Portuguese national ambulance service filed a trademark registration on the symbol, which was granted in 1981. The Portuguese national ambulance service continues to hold a trademark registration in the country, which is used to certify that vehicles are "in accordance with INEM standards" and personnel have "proper preparation ." It may also be used on maps and road signs "to indicate the location or access to qualified emergency medical care services." Belgian EMTs use blue stars while nurses, doctors, and ambulance drivers wear other colors. In the Netherlands, the Star of Life is widely used. The Dutch government owns a trademark on the symbol, alongside the paint scheme used on emergency vehicles. In Germany, the symbol was registered to industry association BKS in 1993. In December 2020, another ambulance industry association DBRD filed a challenge with the German Patent and Trade Mark Office. The challengers hired a law firm  specializing in intellectual property rights to research the symbol's history. This led to allegations the Star of Life had already been in widespread public use since the 1960s, before being registered in Germany (or the US for that matter). The challengers claimed the trademark office seemed to have been not properly informed of these facts, which presumably could have led the original application to have been denied on public domain grounds. The European Union Intellectual Property Office's 2014 rejection of a trademark on a minimally modified Star of Life was also cited."From our point of view, the  'Star of Life' should be returned to its original purpose in the interest of all persons working in the field of rescue services, namely as a general information symbol for all rescue services and not only for members of the BKS. The unrestricted use of the 'Star of Life' in the field of emergency services serves the community and thus all people. To this end, the DBRD defends itself against the trademarks with its applications for invalidity." – DBRD Chairman Marco K. König via translation. Middle East. Most ambulances in Turkey do not use the Star of Life. Ambulances in Iran  commonly display the Star of Life. Egyptian Ministry of Health ambulances display the Star of Life on one rear door, and a red crescent on the other. National Ambulances in the United Arab Emirates does not display the Star of Life, instead showing an EKG graphic on the sides and rear. In Saudi Arabia, the Red Crescent Society answers the emergency line, and provides service in vehicles bearing the crescent emblem. In Israel, Magen David Adom displays a red Jewish star, sometimes shown with a Star of Life. The Jewish star is paired with the red crystal in times of  conflict. Israel's other ambulance operator, United Hatzalah, has a logo based on both stars. "The Star of Life is a universal symbol of emergency medical care. The Star of David is our national symbol. Combining these two elements reminds us of the messages that we...focus on." said United Hatzalah's president. In Palestinian controlled areas, the Palestine Red Crescent Society provides ambulance service in vehicles displaying a red crescent, alongside private operators who often display the Star of Life. India. Indian Automotive Industry Standard AIS-125 is the National Ambulance Code of India. This document is managed jointly by  the Automotive Research Association and the Ministry of Road Transport and Highways. It requires ambulances display several distinctive markings including a reflective Battenburg pattern, the word "AMBULANCE", and the emergency telephone number. The standard states "Displayed on the upper half of the left side should be a 'Star of Life' symbol, with a size of 40cm x 40cm... Displayed on the left back window should be a 'Star of Life' symbol, with a size of 85% of the window". United Kingdom. Some NHS ambulances in the UK display the Star of Life in addition to the local Ambulance  Service emblem. These (latter) emblems have a pale gold six-spoked wheel with a Rod of Asclepius in the foreground. A crown and Maltese Cross, a common EMS emblem in Commonwealth nations, are included in the design. Unicode. The snake-and-staff element of the symbol has a Unicode code point called the Staff of Aesculapius. Some fonts show the Star of Life in this position. Unicode has no dedicated code point for the Star of Life, a restricted symbol in some countries.