The Kingdom of Italy opposed D'Annunzio's actions, demanded that the plotters of the Impresa di Fiume surrender.

Claiming that the Treaty of Rapallo was illegal, D'Annunzio ignored it, and the Italian Regency of Carnaro declared war on Italy.

Following D'Annunzio's precise instructions, the Italian painter, xylographer, illustrator, and photographer Adolfo De Carolis created a model of the medal.

A gold version of the medal awarded to Arturo Toscanini is preserved at the La Scala Theater Museum in Milan.

Eligibility for the medal initially extended to: Under the royal decree of 31 January  1926, the Kingdom of Italy extended eligibility for the medal to members of the Voluntary Militia for National Security (Italian: Milizia Volontaria per la Sicurezza Nazionale, or MVSN), commonly called the "Blackshirts.

The reverse bears the inscription "AI / LIBERATORI / XII-SETTEMBRE/MCMXIX" ("TO THE LIBERATORS 12 SEPTEMBER 1919"), written across four lines, above a laurel wreath.

The first-edition medals were not created with a homogenous minting process, and as a result they varied in weight from 36 to 41.5 grams (1.27 to 1.46 oz).

The second-edition medals were made of dark bronze, were brown or black in color, and varied in weight between 34 and 35 grams (1.2 and 1.2 oz).