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Background: Across the country, cities increasingly rely on Fire Departments and Emergency Medical Services (EMS) to respond to community members experiencing behavioral health crises, addiction, and homelessness. This increasing scope of work can be hard for first responders, who experience a high rate of burnout and turnover. Methods: Through a four-year civic-partnered participatory action research study, we explored the diverse perspectives of people serving on emergency and street-based response teams in an urban setting in northern California. After formative focus groups, we developed and piloted a slate of interventions to strengthen response programs and prevent moral injury and burnout among first responders. Results: First responders identified a wide range of interventions, ranging from structural systems improvement (e.g. expanded shelter hours, more treatment facilities, access to city-wide data systems) to workplace modifications (e.g. no mandatory overtime, increased casual team-building time, complex call debriefs) that would enhance their ability to serve their communities while preventing burnout and moral injury. We collaboratively and iteratively piloted several interventions and evaluated them using a mixed-methods approach. Through these efforts, we developed a model for how moral injury and burnout arise among first responders using an ecosocial approach. Conclusion: Through this partnered participatory action research study, we found moral injury is a salient concern and that modifiable structural and workplace factors are important drivers of risk. There were also challenges to using participatory methods in the context of a hierarchically structured organization designed for emergency response. We discuss lessons learned through navigating these challenges.