From its beginnings, the St. John Ambulance Brigade employed ranks and insignia to distinguish grades within its membership and management structure; these were extended across the wider organisation following its merge with the St John Ambulance Association to form St. John Ambulance. Based upon the British Army officer and the British Army other ranks structure and insignia, the original ranks and insignia have been subject to several modifications over the history of the organisation.
The basic "star" or "pip" has at its center the eight point Maltese Cross, the badge of the Order of St John. The crown used is also that of the Order. At the higher general list ranks, crossed stretchers are used rather than the crossed sword and baton of military use. Insignia are in silver, again symbolic of the Order of St. John.
Since the mid-1990s the former "senior NCO" and "Warrant Officer" ranks have been abolished. These ranks, whose titles were "Staff Sergeant", "Corps Sergeant Major", and "County (or District or Bailiwick) Sergeant Major" were deemed too militaristic in form. Their demise has gone hand in hand with a lowering of emphasis on parading and drill.
Whilst this article uses English St John Ambulance practice as standard, inevitably national variations in rank structure have occurred as the organisation has spread to other countries, and subsequently developed in those countries with a degree of autonomy. The English types are presented in the illustrative tables below. Ranks in other countries are usually similar, but adopt local terminology such as (for example) "Provincial Commissioner" instead of "County Commissioner". There may also be fewer ranks in smaller countries, as a result of the need for fewer rungs of management structure.
| Colour | Red | Grey | Green | Black | Red Stripe | Grey Stripe |
| Insignia (rank slide) |
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| Meaning | Medical practitioners with or without further rank insignia, as below |
Registered nurses with or without further rank insignia, as below |
Registered paramedics with or without further rank insignia, as below |
All other members with or without further rank insignia, as below |
Student doctors when under supervision |
Student nurses when under supervision |
| Rank | Cadet | Cadet Corporal | Cadet Sergeant | Leading Cadet |
| Insignia | . |
| Rank | Member | Corporal | Sergeant |
| Insignia | |||
| Notes | Standard rank slide for members |
Member with leadership responsibilities (no longer issued, may be worn by existing appointees) |
Member with advanced leadership responsibilities and skills |
| Rank | Officer Grade 6 | Officer Grade 5 | Officer Grade 4 | Officer Grade 3 | Officer Grade 2 | Officer Grade 1 | Commissioner |
| Insignia | |||||||
| Notes | Divisional/Medical Officer or Divisional Nurse, 1 Star. | Divisional/Medical Officer or Divisional Nurse, 2 Star. | Divisional Superintendent/Nursing/Medical/Ambulance Officer. Area/County Staff Officer. | Area Commissioner. Area/County Staff Officer. | Assistant Commissioner (Area or County Staff Officer). | Deputy Commissioner (County Staff Officer). | County Commissioner or County Nursing/Medical/Ambulance Officer. Deputy County Commander. |
| Rank | Assistant Chief Officer | Deputy Chief Officer | Chief Officer | Commander | Assistant Chief Commander | Deputy Chief Commander | Chief Commander |
| Insignia | |||||||
| Notes | Assistant Department Head. NHQ Liaison Officer |
Deputy Department Head |
Department Head | Commander - one for each County |
National Third in Command |
National Second in Command |
National Chief Commander |
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