By the time a Frist Responder requires in-patient care, moral injury treatment approaches are often secondary to more pressing clinical concerns around substance detoxfication and managing acute suicidality. Once addressed, PTSD symptomology often presents as somatic manifestations of disrupted sleep, physiological hyperarousal and low motivation, again inhibiting the unpacking of moral injury considerations. Cultural competancy around the vagaries of whatever uniform is involved is essentail to create an authentic third space where the work of therapy may begin, but is often lost in the noise of structured program work and capturing rating scales of distress. This talk outlines why a new approach is needed - one that reframes moral injury around a medical leadership paradigm in order to facilate sustained self-recovery.