From 1938, the British Administration in each of the Malay States established St. John Ambulance Brigade (SJAB) divisions in schools, government establishments and in the Federated Malay States Railways (FMSR). In 1938, the first Ambulance Cadet Division was formed in Pulau Pinang. From 1939, SJAB could be found in Singapore, Pulau Pinang, Melaka, Selangor, Perak, Negeri Sembilan, Pahang, Kelantan, Johor and Kedah. The organisation was led by Dr. Fitzgerald as the President and Dr. Webster as the first District Superintendent who was later succeeded by Capt. Goodman Ambler. Dr. Robert Barr MacGregor was the last St. John Ambulance Association (SJAA) Malaya Chairman and SJAB Malaya District Commissioner before the war broke out.
The early activities were mainly concentrated on educating the public on first aid knowledge and providing training for the Civilian Casualty Clearance Service members. In the beginning, classes were mostly attended by European men only. As manpower shortages became acute, courses were opened to the local men and also women. The Brigade members were first recruited as Stretcher-Bearers and once they were proficient, they were allowed to attend first aid lectures. As qualified Brigade members, they were given free of charge by the Government, one set of khaki uniform, belt, black peak-cap, a pair of black shoes, black water bottle and a white haversack. In early 1941, SJAB organised regular meetings and air raid practices together with the Air Raid Precaution Corps. In September 1941, the Government introduced the Medical Auxiliary Service and all SJAB members were automatically drafted into this service. They were allowed to wear their SJAB uniforms and retain their ranks.
When the Japanese invaded Malaya on 8 December 1941, SJAB members rendered their service at the Casualty Posts. St. John Ambulance was the only voluntary organisation in Malaya rendering first aid services during the war. Many of these members later became the pillars of the St. John Ambulance movement in Malaya, including Encik. E. Paramasivam, St. John Ambulance of Malaysia (SJAM) Commander-in-Chief 1987-1991 and Encik Ng Khoon Hong, SJAM Perak State Commander 1972-1996. In 1946, those who served during the war were paid a war allowance and conferred the Defence Medal by King George VI.