Introduction:Road traffic crashes (RTCs) are common in Qatar, and are now considered the third leading cause of mortality. In this study, the safety devices used by the Qatari public at the time of RTCs were assessed and the association between seatbelt use by vehicle occupants involved in RTCs and severe injury/death in the prehospital setting was determined.Methods:This study was a retrospective case-control investigation. A Hamad Medical Corporation Emergency Medical Services (EMS) database of RTCs occurring from January 2006 to April 2007 was utilized for this study, providing a total of 5,267 patient records (83.5 % male, 16.5% female, median age = 28 years). Patient demographics, crash characteristics, prehospital assessments, and interventions were identified, and use of safety devices was determined. Univariate analysis including chi-square, Student's t-test, and analysis of variance (ANOVA) was performed as appropriate. “Case” patients are defined as those who had specific, critical prehospital assessments, or who received advanced cardio-respiratory life support measures in the field. Logistic regression modeling was used to predict the probability of a case being unbelted, controlling for confounders.Results:Seatbelt use in Qatar was low: 33.9% of males and 32.6% of females wore seatbelts at the time of the RTC. Victims involved in a vehicle rollover crash were less likely to be belted than were those involved in a non-rollover incident (26.2% belted vs. 37.8%; OR = 0.59; 95%CI = 0.50–0.68). Case patients—those with defined critical assessment findings or resuscitation in the field—and control patients were similar in age (30 years vs. 28 years median). Case patients were disproportionately male (89.1% vs. 83.2%; OR = 1.65; 95%CI = 1.01–2.83) and were more likely to be victims of a vehicle rollover crash (44.7% vs. 23.8%; OR = 2.57; 95%CI = 1.84–3.59). Seatbelt use was significantly lower among cases than controls: 19.7% of cases were reported to have worn seatbelts compared to 34.2% of controls (OR = 0.47; 95%CI = 0.31–0.69). This relationship also persisted (OR = 0.51; 95%CI = 0.33–0.76) after controlling for confounders.Conclusions:Seatbelt use in Qatar is low. Seatbelts are protective: in the pre-hospital setting unbelted vehicle occupants involved in RTCs were nearly twice as likely to suffer severe injury or death compared to belted patients. Prehospital morbidity and mortality appears to be reduced significantly by the consistent use of seatbelts by the motoring population in Qatar.