It was created in 1942 and is awarded for single acts of heroism or meritorious achievement while participating in aerial flight. The Air Medal was established by Executive Order. It was awarded retroactive to September 8, 1939, to anyone who distinguishes himself by meritorious achievement while serving with the Armed Forces in aerial flight.
The original award criteria set by an Army Policy Letter dated September 25, 1942, were for one award of the Air Medal. Per each naval vessel or three enemy aircraft in flight confirmed destroyed. Per 25 operational flights during which exposure to enemy fire is expected. Per 100 operational flights during which exposure to enemy fire is not expected. These criteria were altered by the commanding generals of each numbered Air Force to fit the conditions of their theater of operations and to maintain morale.
Would usually be awarded for roughly twice to five times the requirements of the Air Medal. This led to automatic "score card" awards of the Air Medal and Distinguished Flying Cross for completing a set number of operational missions rather than distinguished service, meritorious action, or bravery, as had been intended. Commanders could still issue the awards on those grounds, but the recipient must perform exceptional or meritorious service as well. During World War II, the medal's award criteria varied widely depending on the theater of operations, the aircraft flown, and the missions accomplished. In Europe, the airspace was considered completely controlled by the enemy and heavy air defenses were encountered, so the criteria were altered from those of the original medal.
Bomber, photographic reconnaissance, or observation crewmembers and air transport pilots received it for five sorties, fighter pilots received it for ten sorties, and individual pilots or air crewmen received one award per enemy aircraft shot down. Elsewhere in the Pacific and the China Burma India Theater. The pilots and crews flew mostly over uncontrolled or contested airspace for long hours and lighter air defenses were encountered, so much higher criteria were used. Anti-submarine patrols from the United States could qualify for the medal if an airman logged 200 hours of flight time.