During the National Socialist period, the decoration was adjusted three times (1933-1939).
The original design from 1922 was used until 1934. Between 1934 and 1937 new classes were added. From 1937 the German Swastika was added to the design and the classes were reorganized again.
The Ehrenzeichen des Deutschen Roten Kreuzes German Red Cross Decoration) had two classes between 1922 and 1934:
1- Ehrenzeichen des Deutschen Roten Kreuzes Erste Klasse (First Class)
2- Ehrenzeichen des Deutschen Roten Kreuzes Zweite Klasse (Second Class)
After reorganizing the Order in 1934 the classes became:
1- Stern des Ehrenzeichen des Deutschen Roten Kreuzes (Star)
2- Ehrenzeichen des Deutschen Roten Kreuzes Erste Klasse (First Class)
3- Verdienstkreuz des Ehrenzeichen des Deutschen Roten Kreuzes (Cross of Merit)
4- Ehrenzeichen des Roten Kreuzes (Decoration of the Red Cross)
5- Damenkreuz des Ehrenzeichen des Deutschen Roten Kreuzes (Ladies Cross)
In 1937 the design was changed and the classes reorganized:
1- Grosskreuz des Ehrenzeichen des Deutschen Roten Kreuzes (Grand Cross)
2- Stern des Ehrenzeichen des Deutschen Roten Kreuzes (Star)
3- Erste Klasse des Ehrenzeichen des Deutschen Roten Kreuzes (First Class)Could be awarded with diamonds
4- Verdienstkreuz des Ehrenzeichen des Deutschen Roten Kreuzes (Merit Cross)
5- Zweite Klasse des Ehrenzeichen des Deutschen Roten Kreuzes (Second Class)
6- Medaille des Ehrenzeichen des Deutschen Roten Kreuzes (Medal)
In 1939 the decoration was replaced with the Ehrenzeichen für Deutsche Volkspflege (German Social Welfare Decoration)