Also known as a unit crest or DUI, a Distinctive Unit Insignia is worn by all Soldiers (except General Officers) in units that have been authorized to be issued the device.
It is worn centered on the shoulder loops of the Army Green Service Uniform (AGSU) and the blue Army Service Uniform (Enlisted only) with the base of the insignia toward the outside shoulder seam. DUIs are not worn on the Dress variations of either uniform, however.
Enlisted personnel wear the insignia centered on a shoulder loop by placing it an equal distance from the outside shoulder seam to the outside edge of the shoulder-loop button. Officers (except Generals) wearing grade insignia on the shoulder loops center the DUI by placing it an equal distance between the inside edge of the grade insignia and the outside edge of the button.
Full guidance on wear of the DUI is found in DA Pamphlet 670-1, Section 21-22, "Distinctive unit insignia" and 21–3(d) and (e), "Beret" and "Garrison Cap," respectively.
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Unlike many insignias created for National Guard units, the 109th Medical Battalion Distinctive Unit Insignia displays no imagery pointing to the unit’s home state of Iowa, where it was originally organized in that state’s National Guard. Instead, it focuses on the transcendent nature of providing humanitarian aid and assistance, with only the motto of “Save To Serve Again” serving as a reminder that the Battalion’s ultimate goals are to save Soldier’s lives so that they may, if necessary, rejoin the fight which their wounds or sickness had removed them from.
Maroon and white (silver) are employed in the design to indicate that the organization is a part of the Army Medical Department, while a water bouget—the brown device that resembles the symbol for pi—is a heraldic symbol used to convey the notion of providing relief to combatants and other weary people. The cross in the center is universally seen in military heraldry as a sign of compassionate medical activity, and the fleury is an adaptation of the fleur-de-lis to represent the unit’s history that includes four World War II European campaigns. Red and green found on the scroll are an allusion to the Belgian Fourragere the unit was awarded during the same conflict.
The 109th Medical Battalion unit crest was approved on 17 December 1968.