As the senior non-combat award for heroism, this award hinges on the actual level of personal "life threatening" risk experienced by the awardee. For heroic performance to rise to this level it must be clearly established that the act involved very specific life-threatening risk to the awardee.
During the mid-20th century, the Navy and Marine Corps Medal has been awarded instead of the Silver or Gold Lifesaving Medal, for sea rescues involving risk to life. This is due primarily to the creation of a variety of additional military decorations that are often considered more prestigious than the Lifesaving Medal.
Additional awards of the medal are denoted by gold or silver 5⁄16 inch stars.
