A silver color metal and enamel device 1 3/16 inches (3.02 cm) in height overall consisting of a silver caltrop entwined by a maroon serpent in front of a palmetto tree with silver trunk and green foliage all interlaced by a circular black scroll inscribed "VICTORY IN HEALTH" in silver letters, all centered upon a red cross.
The caltrop, once scattered on battlefields to impede cavalry and troops, represents the battlegrounds where the hospital provides immediate medical attention and evacuation, if necessary. The serpent symbolizes the medical mission of the unit. The serpent, coiled around the caltrop, represents the victory of medicine over the battlefield, and refers to the unit's motto, "VICTORY IN HEALTH." The palmetto recalls the unit's association with the state of South Carolina. Black, along with silver, refers to the night and day capabilities and service provided the solider in the field by the 251st Evacuation Hospital. The red cross symbolizes medical care, green represents healing. Maroon and white (silver) are colors traditionally associated with the Medical Corps.
The distinctive unit insignia was approved on 11 January 1989.