Though service to the sick during times of war had been recognized with prior awards of the Order of the Crown and General Honor Decorations with the Red Geneva Cross, Empress Augusta Victoria the royal patroness of the organization wanted an award to recognize work in peacetime as well.

The First Class was a red enameled Geneva Cross with gilded Prussian Royal Crowns at the ends of the arms.

On the reverse is the inscription in four lines FUER / VERDIENSTE / UM DAS / ROTHE KREUZ (For Merit in the Red Cross).

The design is identical to the silver medal, except it lacks the red enameling of the cross on the obverse.

[citation needed] In 1900, clasps for the medals were created to recognize service in war.