Emergency service personnel routinely encounter highly confronting and traumatic situations involving serious risks to themselves and those they assist, conditions which often challenge their personal ethical and moral frameworks. This study explores how leadership behaviours and organizational characteristics influence moral distress and moral injury among frontline emergency services personnel. Fifty-four Australian emergency responders (65% male; mean age: 50.12 years) completed an online survey containing six open-ended questions addressing their experiences, influential organizational and leadership factors, alignment between personal and organizational values, and recommendations for organizational change. Responses were analysed inductively using thematic analysis. Organizational factors, rather than direct exposure to trauma incidents, were frequently described as primary drivers of moral distress and injury. Specifically, distrust in leadership and perceptions of procedural injustice commonly amplified respondents' vulnerability to moral distress or injury. Participants reported a disconnect between organizational and personal moral values and indicated perceptions of inconsistency between their organization’s' stated and enacted values. Empathetic and supportive leadership behaviours were identified as key protective factors, while bullying, unethical actions, and leader detachment were commonly perceived as exacerbating experiences of moral distress and injury. Notably, some respondents expressed doubt that organizational actions could significantly reduce their moral suffering. These findings underscore the potential importance of attending closely to leadership practices, organizational ethics, and the alignment of organizational values, as these factors appear to be of central importance to the surveyed emergency services personnel.