Background: Given the increased number of four wheel drive (4WD) vehicles in Qatar and their involvement in crashes, casualties and road fatalities, it is important to understand the association between risky driving behavior and 4WD crashes. Aim/Objective: This study aimed to determine the association between risky driving behaviours and 4WD vehicles and its impact on road traffic accidents in the State of Qatar. Materials and Methods: A cross sectional survey was conducted using a multistage stratified cluster sampling technique to recruit 1824 drivers of two wheel drive (small cars) and 4WD across different primary health centres (PHCs) in Qatar. The Driver Behaviour Questionnaire (DBQ) and Driver Skill Inventory (DSI) were used to collect the data. Information regarding socio-demographic and road traffic crashes during last three years was also obtained. Multivariate logistic regression was used to analyse the data. Results: 762 (41.8%) owned 4WD vehicles. Drivers of 4WD were significantly higher between 30-50 years age (P < 0.001), urban dwellers (P = 0.003), having more driving experience (atleast 5 years) (P < 0.001) and annual mileage higher than the drivers of small cars (P < 0.001). A significantly higher proportion of 4WD drivers had previous penalties for traffic violations such as crossing a red traffic signal (51.6% vs. 21.4%; P < 0.001) or exceeding the speed limit (35% vs. 27.8%; P < 0.001). A higher proportion of 4WDs’ drivers reported previous involvement in accidents as compared to the drivers of small cars (42.4% vs. 35.7%; p 0.004). The risk of accident involvement was 1.21 times higher among drivers of 4WD as compared to the counterparts (OR 1.21; 95%CI; 1.01-1.46). Besides, excessive speed, annual mileage, male gender, traffic violations, lapses, errors and driving skills were significantly associated with crashes. Conclusion: The drivers of 4WD cars are at higher risk of crashes as compared to the drivers of small cars. Also, they have significantly more traffic violations, lapses, and errors. Future interventions and control measures should target the drivers of 4WD for better results.