[Federal Register Volume 59, Number 154 (Thursday, August 11, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-19562]


[[Page Unknown]]

[Federal Register: August 11, 1994]


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DEPARTMENT OF TRANSPORTATION
National Highway Traffic Safety Administration
[Docket No. 93-51, Notice No. 2]

 

Criteria for Use of Blue ``Star of Life'' for Emergency Medical 
Services

AGENCY: National Highway Traffic Safety Administration (NHTSA), DOT.

ACTION: Notice.

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SUMMARY: This notice amends NHTSA's guidelines for the authorized use 
of the blue ``Star of Life'' symbol for emergency medical services. 
Comments received in response to an earlier notice suggested uses for 
this symbol that were not considered when these guidelines were first 
developed. These amendments are intended to provide additional 
flexibility to the States within the purposes for which the blue Star 
of Life was originally registered as a certification mark.

EFFECTIVE DATE: September 12, 1994.

FOR FURTHER INFORMATION CONTACT: Susan D. Ryan, Chief, Emergency 
Medical Service Division, National Highway Traffic Safety 
Administration, 400 Seventh Street, SW., Washington, DC 20590; phone 
(202) 366-5440.

SUPPLEMENTARY INFORMATION:

NHTSA's Authority

    The Secretary of Transportation approved the use of the blue ``Star 
of Life'' as a symbol for the Department's Emergency Medical Services 
program in a memorandum dated November 18, 1976. On February 1, 1977, 
the Commissioner of Patents and Trademarks issued to NHTSA a 
certificate of registration for the blue ``Star of Life'' symbol as a 
certification mark.
    This registration gives NHTSA exclusive legal authority to control 
the use of the mark throughout the United States, and remains in effect 
for 20 years. It may be renewed for an additional 10 years in 
accordance with 15 U.S.C. section 1059.

Current Guidelines

    In accordance with its registration as a certification mark, the 
blue ``Star of Life'' may be used on emergency medical care vehicles to 
certify that they meet DOT standards, by emergency medical care 
personnel to certify that they are trained to meet DOT standards, and 
on road maps and highway signs to indicate the location of or access to 
qualified emergency medical care services.
    In a memorandum dated September 14, 1977, NHTSA authorized States 
and Federal agencies that are involved with emergency medical services 
to permit use of the blue ``Star of Life'' certification mark in 
accordance with criteria and specifications outlined in the memorandum.

Request for Modification of Guidelines

    In July 1992, a State requested an advisory opinion from NHTSA on 
the use of the blue ``Star of Life'' symbol in the State's Emergency 
Medical Services-Do Not Resuscitate (EMS-DNR) program. The State 
proposed to use the mark to alert State certified prehospital emergency 
medical care providers that a person wearing a bracelet which displays 
the ``Star of Life'' and the letters ``EMS-DNR'' does not wish to be 
resuscitated. NHTSA determined that this use does not meet the criteria 
outlined in the memorandum dated September 14, 1977. Accordingly, NHTSA 
denied the State's request to use the ``Star of Life'' in connection 
with the EMS-DNR program.
    In response to NHTSA's decision to deny the State's request, the 
National Association of EMS Physicians (NAEMSP), the National 
Association of State Emergency Medical Services Directors (NASEMSD), 
and the American College of Emergency Physicians (ACEP) contacted NHTSA 
to express their support for use of the blue ``Star of Life'' by the 
State's EMS-DNR program. These organizations made four primary 
arguments in support of the proposed use of the ``Star of Life'' for 
EMS-DNR purposes.
    First, they contended that the proposed use would provide EMS 
personnel with a consistent location where they could look for EMS 
orders on terminally ill persons who desire not to undergo 
resuscitation. The organizations indicated that they consider the 
proposed use appropriate because the DNR bracelet would alert EMS 
personnel of a medical condition or appropriate medical treatment.
    Second, the organizations asserted that the ``Star of Life'' is a 
unique symbol widely recognized by EMS personnel, which has come to 
symbolize the entire EMS system rather than the limited criteria in the 
September 1977 NHTSA memorandum.
    Third, the organizations contended that since NHTSA has 
``historically'' granted State EMS offices some discretionary authority 
regarding use of the ``Star of Life,'' NHTSA should allow State EMS 
offices to determine the use of the ``Star of Life'' on EMS-DNR 
bracelets within their respective States.
    Finally, at the time the guidelines were developed, the 
possibilities for the use of the ``Star of Life'' on a DNR bracelet 
were not considered. The organizations urged NHTSA to reexamine the 
appropriate use of the symbol and either rescind or reissue the 
guidelines to permit such use.

Federal Register Notice Requesting Comments

    NHTSA continued to have concerns about expanding the authorized 
uses of the blue ``Star of Life.'' However, it also recognized that the 
current guidelines for the authorized use of the blue ``Star of Life'' 
certification mark had not been revised since their publication in 
September 1977.
    Accordingly, the agency decided that it was appropriate to 
reevaluate the guidelines in view of the current trends and possible 
uses for the symbol and to examinate the symbol's purpose and whether 
it should be expanded at this time.
    On August 3, 1993, NHTSA published a notice in the Federal Register 
(58 FR 41316) announcing that it was considering whether to expand the 
purposes for which the blue ``Star of Life'' could be used and whether 
other changes to the guidelines for the authorized use of the symbol 
would be appropriate.
    The notice requested comments from the public on whether the agency 
should authorize the use of the ``Star of Life'' symbol in EMS-DNR 
programs, including its use on personal items, such as bracelets or 
necklaces, to identify individuals who are DNR candidates. The notice 
also requested comments on whether the agency should make other 
revisions to its guidelines for the authorized use of the blue ``Star 
of Life.''

Comments Received

    Eighteen comments were received by the agency in response to the 
August 3 notice. Commenters included one Federal agency (the U.S. Fire 
Administration), two national organizations (the American College of 
Emergency Physicians and the National Association of State EMS 
Directors), one medical school, eight State EMS Directors, four 
regional or local EMS officials and an interested individual.
    Each of the comments addressed the central issue concerning whether 
to permit the use of the ``Star of Life'' symbol for DNR purposes. In 
addition, some comments made suggestions regarding other aspects of the 
criteria and specifications that were outlined in 1977.

Use of ``Star of Life'' for Do Not Resuscitate Programs

    Of the eighteen comments received, only two States, two regional or 
local EMS officials and an interested individual opposed the use of the 
``Star of Life'' symbol for a DNR program. The Federal agency, the 
medical school, both national organizations, six States and two 
regional or local EMS officials either supported or stated that they 
did not oppose the use of the ``Star of Life'' symbol for DNR purposes. 
Many of these comments expressed strong support for the symbol's use 
for these purposes.
    To assist the agency in deciding whether to permit the use of the 
``Star of Life'' for this purpose, NHTSA requested in its August 3, 
1993 notice comments addressing a number of specific questions. These 
questions, and the comments we received responding to them, are 
discussed below.

1. State EMS-DNR Programs

    NHTSA requested that comments provide examples of State EMS 
programs that have developed or are developing EMS-DNR identification 
programs and the identification symbols used in those programs.
    The comments reported that the States of California and Virginia 
have developed statewide DNR programs. Genesee County, MI also reported 
that it has a DNR program. Virginia employs the ``Star of Life'' 
symbol; California employs the Medic-Alert symbol; Genesee County uses 
a purple wrist identification bracelet. The States of Washington, Maine 
and Maryland are all in the process of developing DNR programs. Each of 
these States indicated that it is interested in or would strongly 
consider using the ``Star of Life'' for its DNR program.

2. Confuse the Public

    NHTSA sought comments on whether the proposed use of the ``Star of 
Life'' symbol would confuse the general public. In particular, the 
agency asked whether the use would likely confuse the public as to the 
identification and location of qualified EMS personnel and equipment.
    Comments from California, San Diego, the Northern Mariana Islands 
and the Genesee County Medical Control authority in Genesee County, MI 
predicted that use of the ``Star of Life'' for DNR purposes would 
confuse the public. More specifically, California stated, ``use of the 
`Star of Life' on DNR bracelets would likely confuse individuals as to 
the identification of qualified EMS personnel.'' However, no evidence 
was cited for this prediction.
    Virginia (which uses the ``Star of Life'' symbol for its DNR 
program) reported that there have been no instances of confusion. In 
addition, the State asserted its belief that it ``would be very 
unlikely that anyone would mistake the patient with such a bracelet * * 
* for a qualified EMT,'' since patients who are eligible to wear such 
bracelets have been diagnosed with a terminally ill condition. The U.S. 
Fire Administration, the National Association of State EMS Directors 
and the State of New Jersey agreed with Virginia that use of the ``Star 
of Life'' symbol for DNR programs is extremely unlikely to confuse the 
public.

3. Difficulty with Identification.

    NHTSA requested that States with established EMS-DNR programs 
explain the difficulties, if any, that EMS personnel are encountering 
with the identification symbols used for EMS-DNR candidates.
    Virginia (which uses the ``Star of Life'' symbol) and California 
and San Diego (which use the Medic-Alert symbol) all reported that they 
were aware of no problems of identification or verification with the 
system they use.

4. Benefits and Disadvantages

    NHTSA requested that comments discuss the benefits and 
disadvantages that are likely to result from using the ``Star of Life'' 
to identify persons requesting a particular treatment or withholding of 
treatment by qualified EMS personnel.
    California and San Diego commented that they saw no benefit to 
expanding the use of the ``Star of Life'' symbol regarding the 
identification of patients who elect to execute DNR directives. In 
fact, California saw it simply as a training issue. The State said EMTs 
could as easily be trained to identify DNR candidates using other 
symbols.
    California also asserted that use of the ``Star of Life'' for DNR 
services would be contrary to NHTSA training programs, which focus on 
the search for a Medic Alert bracelet to determine vital patient 
information. Comments from Virginia, on the other hand, point out that 
the DOT National Standard Curricula provide for EMTs and others ``to 
check a patient's `Medic Alert' bracelet as part of the patient 
assessment after initial resuscitative measures have been carried 
out.''
    California is correct that the DOT National Standard Curricula 
advise EMTs and others to seek patient information from medical 
identification items, such as ``Medic Alert'' bracelets. However, NHTSA 
disagrees that use of the ``Star of Life'' for DNR purposes is contrary 
to this training. As explained in Virginia's comments, EMTs and others 
are trained to seek patient information (as part of patient assessment) 
only after advanced directives (such as initial resuscitative measures 
and other treatment and transportation protocols) are followed. The 
1994 edition of the DOT National Standard Curriculum for EMT-Basic 
makes clear the distinction between patient identification information 
and advanced directives. The Curriculum also indicates that the use of 
advanced directives (such as DNR) is a State issue and informs 
instructors to modify the curriculum to accommodate those advanced 
directives used in the State where the instruction is taking place.
    A few commenters expressed the concern that use of the symbol for a 
DNR program would either dilute or be entirely incompatible with the 
original meaning of the ``Star of Life.'' Leo R. Schwartz, who was 
Chief of NHTSA's Emergency Medical Services Division at the time the 
symbol was developed and registered as a certification mark with the 
Commissioner of Patents and Trademarks, argued that the mark was 
envisioned as and should remain ``a symbol of life,'' not a ``barrier'' 
to care. He strongly objected to the use of the ``Star of Life'' with 
an ``act of omission, with death as an end result.''
    Others disagreed with these comments, and strongly supported 
expansion of the use of the symbol. A number of comments, for example, 
recognized that the role of EMS has expanded since 1977, when the 
``Star of Life'' was first registered as a certification mark, and 
asserted that the proposed expanded use of the symbol is not 
incompatible (indeed it is appropriate) with current broader EMS 
missions.
    Other comments went further. The Department of Fire/Rescue 
Services, Frederick County, MD stated:

    The current request for an EMS-DNR program use is consistent 
with the direction of modern, managed health care, where the patient 
may give advance directives for their level of treatment. This is 
going to be more apparent in the health care reform recommendations 
that will be published in the near future.

    Similar sentiments were expressed in comments from Dr. Nicholas 
Benson, East Carolina University School of Medicine:

    As our nation becomes more involved with health care reform, one 
of the key issues to be resolved is which patients with sudden 
cardiac death should be resuscitated and which should not * * * 
Physicians, including myself, do not wish to make this determination 
alone; this is a decision that must include the express wishes of 
the patient, or his/her legal guardian. The Prehospital Do Not 
Resuscitate programs across the nation seek to respond to this need 
by predetermining which patients wish to be resuscitated and under 
what conditions. NHTSA's cornerstone contribution to this should be 
the use of the Star of Life, because of its long-standing use as a 
symbol denoting professionalism and compassion in prehospital care.
    As the profession of EMS has grown in the past 20 years, the 
implications of the use of the Star of Life have grown, as well. It 
has become a universally recognized symbol of professionalism and 
expertise in emergency medical care. The use of the Star of Life in 
Prehospital Do Not Resuscitate programs is 100% consistent with this 
growth.

    The benefit most often cited in support of using the ``Star of 
Life'' symbol for DNR purposes is the level of recognition enjoyed by 
the symbol. The comments were uniform in their acknowledgement of how 
highly visible and widely recognized the symbol has become. The U.S. 
Fire Administration commented that, ``EMS personnel are already trained 
to look for these bracelets, and as such save valuable time in 
situations where time is a critical factor.'' Maine EMS stated, ``The 
decision to begin resuscitation must be rapidly made by EMS personnel 
if it is to [be] implemented successfully * * * The Star of Life, alone 
or as part of a logo, is instantly recognized by EMS personnel * * * 
The availability of this universal symbol will greatly assist in this 
purpose.''
    The States of Washington and New Jersey could think of no 
disadvantages to using the ``Star of Life'' for a DNR program.

5. Competitive Effect

    NHTSA requested comments on the competitive effect of the proposed 
``EMS-DNR'' bracelet/``Star of Life'' symbol on private organizations 
that offer services which alert EMS personnel to a patient's condition. 
We received no comments alleging any adverse competitive effects. One 
State commented that, if there are any such adverse effects, they will 
have to yield to the more important public interest in the use of 
symbols that are universally recognized.

6. Use of Symbol for Other Medical Conditions

    Comments were sought regarding whether the agency should authorize 
the use of the ``Star of Life'' symbol for services or programs that 
would alert EMS personnel to other medical conditions of a patient, 
i.e., diabetes, heart disease, high blood pressure.
    Comments on this issue generally tracked the commenter's position 
on the use of the ``Star of Life'' for DNR. Commenters (such as 
Maryland) that favored use of the ``Star of Life'' for DNR purposes, 
supported the symbol's use for diabetes, heart disease, high blood 
pressure or other medical conditions. Commenters (such as San Diego) 
that did not favor use of the ``Star of Life'' for DNR purposes, 
opposed the symbol's use for these other purposes.
    The State of California, however, expressed a different view. While 
it opposed use of the ``Star of Life'' for DNR purposes, it stated that 
if the symbol is approved for use in DNR programs, its use should also 
be approved for services and programs that will alert EMS personnel to 
other medical conditions of the patient.

Change to Specifications for Use of Symbol

    Based on the weight of the comments received, NHTSA has decided to 
amend the specifications. As amended, States and Federal agencies with 
emergency medical services involvement are authorized to permit use of 
the ``Star of Life'' symbol to alert emergency care providers to 
medical conditions or to identify appropriate treatment.
    The States and Federal agencies then will have the authority to 
determine within their respective jurisdictions the medical conditions 
(i.e., diabetes, heart disease, high blood pressure) and the treatments 
(i.e., DNR) they wish to include. The ``Star of Life'' would be used 
for these purposes, in accordance with programs established by the 
State or Federal agency. This decision is consistent with many of the 
comments that favored giving States some discretionary authority to 
determine the appropriate uses for the ``Star of Life'' within their 
borders.

Other Issues Raised

    Many of the comments pointed out that the ``Star of Life'' is 
currently being used in ways that are not restricted to ``certified'' 
vehicles and personnel. For example, they stated that the symbol is 
being used on patient care products, on personal items used by EMS 
personnel, and in logos of national, state and local EMS organizations. 
In addition, they alleged that many of the logos use formats that do 
not comply with the 1977 specifications. Some of the comments went so 
far as to question whether, as a result of such varied uses and 
formats, the ``Star of Life'' has become generic and lost its validity 
as a certification mark.
    The commenters who noted that the ``Star of Life'' symbol is being 
used in ways, other than on ``certified'' vehicles and personnel, are 
correct. These uses are appropriate, provided they fall within the 
scope of the Criteria for the Use of the ``Star of Life'' Symbol. The 
criteria that were established in 1977 provided for the symbol to be 
used not only on ambulances and to indicate the location of EMS 
personnel, but also ``to identify medical equipment and supplies for 
installation and use in . . . ambulances;'' ``on EMS personal items 
such as badges, lapel pins, plaques, buckles, names plates, etc.;'' 
``on printed material having direct EMS application such as books, 
pamphlets, letterheads . . .'' and ``[by] entrepreneurs engaged in the 
production of goods or publication of printed material [having direct 
EMS application].'' As explained below, NHTSA has made some changes to 
these criteria in today's notice, but in general continues to support 
these related uses of the ``Star of Life.''
    There have been attempts to use the symbol for purposes that are 
not EMS-related (such as in connection with furniture or automobile 
repair businesses). When these inappropriate and unauthorized uses have 
come to NHTSA's attention, we have taken immediate steps to ensure that 
they do not continue. We strongly disagree that the symbol has become 
generic or lost its validity.
    The agency recognizes that the ``Star of Life'' is currently being 
used or has been incorporated into the logos of some EMS organizations 
using formats that do not comply strictly with the 1977 specifications. 
We have decided some additional flexibility in this area is warranted 
and have, therefore, changed this aspect of the 1977 specifications, as 
explained below.
    Some comments suggested that NHTSA, as well as State EMS Directors, 
should support additional programs aimed at educating the public about 
the meaning of the ``Star of Life'' symbol and when and how the symbol 
is to be used. The comments recommended also that efforts to supervise 
its proper use should be increased.
    NHTSA will continue to take steps against the inappropriate and 
unauthorized use of the ``Star of Life'' symbol of which it becomes 
aware. We encourage State EMS Directors, or others in the EMS field, to 
bring such uses to the agency's attention. We also encourage State EMS 
Directors to educate EMS personnel on the proper use of the symbol, and 
to educate the public in their respective States on matters such as how 
to recognize and when to look for the ``Star of Life.''
    One commenter seemed to believe that, since NHTSA owns the 
certification mark to the ``Star of Life,'' the symbol may be used by 
NHTSA alone. We believe this comment reflects a misunderstanding of the 
nature of certification marks.
    Unlike a trade or service mark, which creates for the owner 
exclusive rights to use the registered symbol, a certification mark is 
owned by one person and used by others. Such a mark is to be used, for 
example, to certify quality or other origin.
    The ``Star of Life'' symbol was registered and is owned by NHTSA. 
NHTSA has authorized its use to certify compliance with certain 
standards (such as compliance by an ambulance with Federal 
Specifications or completion by EMS personnel of appropriate training 
courses). NHTSA has also authorized its use on goods employed or in 
connection with services performed as part of EMS systems, at the 
national, State or local level.

Other Changes to Criteria and Specifications

    NHTSA requested comments on whether the agency should make other 
revisions to the criteria and specifications that were established on 
September 14, 1977. We received extensive and thoughtful comments from 
the National Association of State EMS Directors (NASEMSD). We have 
adopted some of the changes recommended by NASEMSD, as well as some 
additional changes based on our own review.
    Many of the criteria have been amended to make them less 
restrictive. Some of the criteria, particularly those sections that 
attempted to detail the appearance of the ``Star of Life'' for various 
uses, have been deleted entirely and replaced instead with more general 
instructions and restrictions.
    As amended, the criteria provide that the ``Star of Life'' may be 
used on emergency care vehicles that either meet Federal specifications 
or are authorized to be used for emergency responses by a State or 
Federal agency. They continue to provide that the symbol may be used to 
indicate the location of and access to qualified emergency medical 
care.
    The criteria clarify that the ``Star of Life'' may be worn or used 
on patches, badges, lapel pins and other similar items by persons who 
have completed training and are authorized by a State or Federal agency 
to provide EMS care and by persons who by title and function are 
involved in the administration or supervision of or otherwise 
participate in an EMS system.
    As explained above, the criteria have been amended to provide that 
the ``Star of Life'' may be used to inform providers of medical 
conditions (such as diabetes) or to identify appropriate treatment 
(such as DNR), in accordance with programs established by the State or 
Federal agency.
    The criteria continue to provide that the symbol may be used on EMS 
training materials, other materials (such as letterheads and 
publications) having direct EMS application, medical equipment and 
supplies intended for use by EMS providers and by entrepreneurs engaged 
in the production or publication of these items.
    With regard to the appearance of the ``Star of Life,'' the 
specifications continue to include a sample of the registered blue 
``Star of Life'' symbol and to identify the color of the symbol and its 
dimensions. The criteria, as amended, indicate that deviations in size 
may be made, provided they are proportionate, and that other deviations 
may be made, provided they create the same commercial impression 
created by the registered mark. Deviations which change the basic, 
overall commercial impression created on the public are not permitted.
    The criteria continue to provide instructions for including the 
symbol to show that the ``Star of Life'' is a registered certification 
mark. They have been amended to provide that some manner of demarcation 
should be used on patches, lapel pins and other similar items to 
distinguish whether the person wearing such item is an EMS provider or 
an individual involved in the administration or supervision of an EMS 
system. Provisions that attempted to detail the appearance of the 
``Star of Life'' for these and other uses have been deleted.
    Appendix A to this notice contains the revised criteria and 
specifications for the Use of the ``Star of Life'' Symbol.

    Issued on: August 5, 1994.
Michael Brownlee,
Associate Administrator for Traffic Safety Programs.

Appendix A

Criteria and Specifications for the Use of the ``Star of Life'' 
Symbol

    The ``Star of Life'' is a certification mark that was issued on 
February 1, 1977 (Certificate of Registration No. 1,058,022), by the 
Commissioner of Patents and Trademarks to the National Highway Traffic 
Safety Administration (NHTSA).
    The certification mark is to be used on emergency medical care 
vehicles to certify that they meet Federal standards; by emergency 
medical care personnel to certify, based on their training and 
affiliation with a qualified emergency medical care system, that they 
are authorized to provide emergency medical care; on road maps and 
highway signs to indicate the location of or access to qualified 
emergency medical care services; and such other EMS-related uses that 
the Administrator of the National Highway Traffic Safety Administration 
(NHTSA) may authorize. Any other use is prohibited. Unauthorized use 
shall be reported to the NHTSA Administrator for investigation and 
legal action as may be required.
    NHTSA authorizes the States (as defined in 23 U.S.C. Sec. 401) and 
Federal agencies with EMS involvement to permit use of the ``Star of 
Life'' symbol for the following purposes:
    1. To identify emergency medical care vehicles that meet the 
Federal Specifications for Ambulances--Emergency Care Vehicles (KKK-C-
1822 GSA-FSS) or are authorized by a State or Federal agency involved 
in the provision of emergency medical care to respond to scenes 
requiring the provision of emergency medical care.
    2. To indicate the location of and access to qualified emergency 
medical care services.
    3. On patches or other apparel or personal items (such as badges, 
lapel pins, buckles, name plates, plaques, etc.) worn or used by an 
individual:
    a. who:
    i. has satisfactorily completed any training course that meets or 
exceeds the U.S. Department of Transportation National Standard 
Curricula or has been approved by a State or Federal agency involved in 
the provision of emergency medical care; and
    ii. is authorized by a State or Federal agency involved in the 
provision of emergency medical care to participate in a qualified 
emergency medical care system; or
    b. who by title and function is authorized by a State or Federal 
agency involved in the provision of emergency medical care to 
administer, directly supervise, or otherwise participate in all or a 
specific part of a qualified emergency medical care system.
    4. On bracelets or other items of apparel worn by a patient to 
inform authorized emergency medical care providers to medical 
conditions or to identify appropriate treatment with regard to that 
patient, in accordance with programs established by a State or Federal 
agency involved in the provision of emergency medical care.
    5. On training materials that meet or exceed the U.S. Department of 
Transportation National Standard Curricula or have been approved by a 
State or Federal agency involved in the provision of emergency medical 
care.
    6. On materials such as books, pamphlets, letterheads, plans, 
manuals, reports, and publications that either have direct EMS 
application or were generated by an EMS organization. An EMS 
organization is an organization that either is involved in the 
provision of emergency medical care or represents persons or 
organizations who are so involved.
    7. To identify medical equipment and supplies intended for use by 
authorized emergency medical care providers in the provision of 
emergency medical care.
    8. By entrepreneurs engaged in the production of medical equipment 
and supplies or the publication of materials described above.
    The following restrictions apply to the use of the ``Star of 
Life'':
    1. As a registered certification mark, the ``Star of Life'' must 
always be accompanied by the symbol consisting of a capital letter R 
surrounded by a circle, i.e. . This marking shall appear 
immediately adjacent to the ``Star of Life'' on all decals, uniform 
patches, printed material, plaques, pins, buckles, name plates, etc. 
Where the item consists solely of the ``Star of Life'' and does not 
have an adjacent surface of surrounding area (e.g., a lapel pin), the 
 shall appear on the reverse side of the item.
    2. The Specifications below include a sample of the registered blue 
``Star of Life'' symbol, and identify the color of the symbol and its 
dimensions (for three sizes). Deviations in size may be made, provided 
they are proportionate. Other deviations may be made, provided they 
create the same commercial impression created by the registered mark.
    3. Some manner of demarcation (such as function-identifying words 
or letters printed on bars and attached across the bottom separately, 
and edging of different colors) should be used on patches or other 
apparel or personal items (such as badges, lapel pins, buckles, name 
plates, plaques, etc.) worn or used by an individual, to distinguish 
those worn or used by an individual:
    a. who:
    i. has satisfactorily completed any training course that meets or 
exceeds the U.S. Department of Transportation National Standard 
Curricula or has been approved by a State or Federal agency involved in 
the provision of emergency medical care; and
    ii. is authorized by a State or Federal agency involved in the 
provision of emergency medical care to participate in a qualified 
emergency medical care system;

from those worn or used by an individual:
    b. who by title and function is authorized by a State or Federal 
agency involved in the provision of emergency medical care to 
administer, directly supervise, or otherwise participate in all or a 
specific part of a qualified emergency medical care system.

Specifications

BILLING CODE 4910-59-P

TN11AU94.004


[FR Doc. 94-19562 Filed 8-10-94; 8:45 am]
BILLING CODE 4910-59-C