A gold color metal and enamel device 1 3/16 inches (3.02 cm) in height overall, consisting of a scarlet Greek cross bearing in the center a gold fleur-de-lis between, horizontally, two five-pointed gold stars, the ends of the horizontal arms of the cross each resting on a vertical white bale of cotton banded gold and the upper vertical arm of the cross in front of the lower and white half of an arc with wavy outer edge divided horizontally scarlet and white, and terminating at the upper ends of the cotton bales, all above a continuous maroon scroll lined white and inscribed "BETWEEN LIFE AND DEATH," the scroll touching the lower ends of the cotton bales, folded back and passing behind the end of the lower vertical arms of the cross, and with all interior areas between the cross, cotton bales, arc and motto scroll blue.
The cross, a symbol of aid and assistance, refers to the Hospital, the fleur-de-lis and two stars alluding to the unit's participation in service in the Rhineland and Central Europe campaigns during World War II. The red and white wavy arc alludes to the Red River of Shreveport, Louisiana, where the unit was formerly located. The cotton bales refer to the production and shipping of cotton, important industries to the area. The "double" arc refers to the speed and mobility by land conveyance or by air in the collection, treatment and further evacuation or return to duty of wounded and other casualties from combat. Maroon and white are the colors used for Medical organizations.
The distinctive unit insignia was originally approved for the 114th Evacuation Hospital on 16 July 1970. It was redesignated for the 114th Combat Support Hospital, effective 16 September 1993, with the description and symbolism revised.