Causality factors, the responsibility of the driver and driver fatigue-related factors were studied in fatal two-vehicle accidents where a trailer truck driver was involved during the period of 1991-1997 (n = 337). In addition, 251 long-haul truck drivers were surveyed in order to study their views regarding contributing factors in accidents involving trucks and the development of possible countermeasure against driver fatigue. Trailer truck drivers were principally responsible for 16% of all the accidents. Younger driver age and driving during evening hours were significant predictors of being principally responsible. In addition, the probability of being principally responsible for the accident increased by a factor of over three if the driver had a chronic illness. Prolonged driving preceding the accident, accident history or traffic offence history did not have a significant effect. Only 2% of the drivers were estimated to have fallen asleep while driving just prior to the accident, and altogether 4% of the drivers had been tired prior to the accident. Of the drivers 13% had however, been driving over 10 h preceding the accident (which has been criminally punishably in Finland since 1995 under the EC regulation) but no individual factors had a significant effect in predicting prolonged driving. The surveyed views regarding causes of truck accidents correspond well with the accident analysis. Accidents were viewed as being most often caused by other road users and driver fatigue was viewed to be no more than the fifth (out of eight) common cause of accidents. The probability of viewing fatigue as a more common cause increased significantly if the driver had experienced fatigue-related problems while driving. However, nearly half of the surveyed truck drivers expressed a negative view towards developing a technological countermeasure against driver fatigue. The negative view was not related to personal experiences of fatigue-related problems while driving.