This study investigates accident fatalities involving two types of off-road vehicles: snowmobiles and all-terrain vehicles (ATVs). All snowmobile fatalities in Sweden from the 2006/2007 season through the 2011/2012 season, and all ATV fatalities from 2007 through 2012, were retrospectively examined. A total of 107 fatalities—57 snowmobile-related and 50 ATV-related—were found. Most deaths occurred on weekends (71% of the snowmobile-related and 72% of the ATV-related). A majority of the fatalities were males (91% and 94%), with the largest share in the age group 40–49 years (19% and 24%). The most common causes of death were blunt trauma (56% and 66%), drowning (30% vs 6%), and traumatic asphyxia (9% vs 14%). Among victims who were tested (95% vs 92%), a very high share was found to be inebriated (59% vs 61%), and mean blood alcohol concentration was also high (1.9 vs 1.7 g/l). Forty-seven percent of snowmobile-related fatalities and 48% of ATV-related fatalities had a blood alcohol concentration above 1.0 g/l. This means that there was a very strong association between off-road vehicle fatalities and drunken riding; steps to prevent riding while intoxicated seem to be the most important preventive measure. Automatic measures such as alcolocks are probably the most effective. The obvious at-risk group to target is middle-aged men with high alcohol consumption.