Ribbon: Red with diagonal yellow stripes.

Instituted: March 15, 2007 by the Secretary of the Air Force Michael W. Wynne.

Awarded: To members of the United States Air Force through the grade of colonel (O-6) who come under direct and hostile fire while operating in unsecured space (outside a defended perimeter) or who personally engage hostile force with direct and lethal fire, since 11 September 2001.