From its beginnings,<unk> <unk>  Ambulance employed<unk>  and<unk>  to distinguish grades within its membership and management<unk> ructure; these were extended across the wider organisation following its merge with the<unk> <unk>  Ambulance Association to form<unk> <unk>  Ambulance. Based upon the British Army officer and the British Army other<unk> <unk> ructure and<unk> , the original<unk>  and<unk>  have been subject to several modifications over the history of the organisation. The basic "star" or "pip" has at its centre the eight-point Maltese Cross, the badge of the Order of<unk> <unk> . The crown used is also that of the Order. At the higher general list<unk> , crossed<unk> retchers are used rather than the crossed sword and baton of military use.<unk>  are in silver, again symbolic of the Order of<unk> .<unk> . Also, officers who hold<unk> within the organisation at or above R4 wear a cockade in their hat (women) and have a silver bar (men), however at or above R3 wear a cockade and tuft (women) and silver bar and Wort cap (men). Since the mid-1990s the former "Senior NCO" and "Warrant Officer"<unk>  have been abolished. These<unk> , whose titles were "Staff Sergeant", "Corps Sergeant Major", and "County (or District or Bailiwick) Sergeant Major" were deemed too militaristic in form although a few previous incumbents remain. Their demise has gone hand in hand with a lowering of emphasis on parading and drill. The county Sergeant Major, if the county has appointed one, wears member<unk> slides and Warrant Officer Class 2 <unk> <unk>  Crown in laurel leaves) arm badges on the bottom of each arm. Nurses used to wear Rhodium Metal bars on their Shoulder<unk> raps. A red enamelled bar denoted a<unk> ate Registered Nurse (SRN). A purple enamelled bar denoted a<unk> ate Certified Midwife (SCM) and/or a Nurse on the Special Part of the<unk> ate Register i.e. psychiatric or learning disability). A green enamelled bar denoted a<unk> ate Enrolled Nurse (SEN). Their use was abandoned in the mid-1990s. In 2012, one Warrant Officer Class 1 (wearing Royal Arms badges in silver on both arms) was appointed at National HQ to advise on ceremonial matters across<unk> <unk>  Ambulance. In December 2013, as a result of the<unk> review, a simplified<unk><unk> ructure was introduced, being fully implemented by the end of March 2014. The aim of the new<unk><unk> ructure is to ensure that<unk> is applied consistently throughout the organisation and that it is applied only based on an individual's role. A number of<unk>  will cease to exist as a result of this change, and the requirements for many of the remaining<unk>  will change. In December 2016, it was announced that effective 1 January 2017, no<unk> is to be worn on events, except by persons who are performing an operational management role at that event. Persons who are undertaking an operational management role, but who do not have<unk>  will continue to not wear<unk>  Persons who do have<unk>  but who are not in an operational management role at the event should not display their<unk>
Ranks and insignia of St John Ambulance 
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