The Hell's Jerome medal is awarded after killing 15 players in a row without dying in the Halo: Reach multiplayer matchmaking playlist Living Dead. It resembles a green zombie head with a purple circular background on top of a six pointed silver star. It is the last of the zombie killing spree medals on Halo: Reach and can only be awarded in the Living Dead playlist.
- The medal's name may be a reference to Jerome Simpson, Bungie's Head of Security.
- The medal's name may be a reference to the Catholic saint Jerome, who would spend many hours of penance in the crypts of the dead, which he described as Hell.