From 1985 through 1997, the U.S. Consumer Product Safety Commission (CPSC) identified 113 deaths associated with all-terrain vehicles (ATVs) in West Virginia. This report summarizes data from the CPSC ATV-related death database and on-site and/or follow-up telephone investigations; findings indicate that approximately two thirds of deaths were caused by injury to the head or neck. Consistent use of helmets by riders can substantially reduce ATV-related deaths.