A retrospective analysis of 1,259 patients injured in all-terrain vehicle accidents over a 2-year period was performed. All patients presented to the same community hospital Emergency Department, located near a major desert off-road vehicle recreational area. The patients were characterized by demographics and Injury Severity Scores. There were 2,149 recorded injuries. Mean ISS +/- standard deviation for all patients was 5.07 +/- 4.93; among patients admitted for inpatient care, 9.83 +/- 6.46. Injury Severity Scores were independent of vehicle type (two, three, or four wheels). In this setting, injuries sustained by children were not disproportionately more severe than those sustained by adults. Where documented, alcohol use was associated with higher ISS, and the use of helmets was associated with less severe head and facial injuries. The most common diagnoses in this series were integumental injuries and fractures, frequently involving the face and extremities.