Off-road vehicle crashes account for over 3% of all motor vehicle crash related emergency department (ED) visits in North Carolina and are an increasingly serious problem. State legislators and ATV safety groups have recognized off-road vehicle safety as a significant problem and have undertaken efforts to reduce off-road vehicle crashes. The research component of this master’s paper is a study to identify off-road motor vehicle rider demographics, patterns of injury, and type of injuries requiring ED visits in North Carolina. Information was obtained from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) database, which collects data for over 99% of ED visits in North Carolina. Patients in rural areas, male patients, and pediatric and young adult patients were particularly vulnerable to off-road vehicle crash injuries. Injuries were often sustained to the extremities and head, and the injury type was most often contusions, fractures, or sprains/strains. The systematic review portion of this master’s paper was conducted with the goal of determining the effectiveness of ATV state legislation in preventing injuries and deaths related to ATV use. The review focused on ATVs because it was the off-road vehicle type most often studied. Studies have found that ATV crash injuries and deaths can be prevented or reduced in severity with appropriate injury prevention efforts; however, ATV state legislation has resulted in modest to no change in ATV-related injuries. Future injury prevention efforts should focus on education and compliance with ATV state legislation, particularly among younger age groups.