Between 2002 and 2014 there have been over 150 reported incidents, including 4 fatalities, involving motor vehicles on the world heritage listed sand island Fraser Island (K’gari), off the southern Queensland coast, Australia. While regulation has been established, the beach as a roadway environment is complex and is a unique challenge for drivers. This paper describes the results of applying two systems analysis approaches, Accimap and Cognitive Work Analysis (CWA), to explore beach driving. Accimap is used to describe the actors within the system and the contributory factors involved in two recent fatal incidents. CWA is then used to describe the beach driving system within which these accidents are occurring, including the range of constraints impacting behaviour. The findings show that beaches present as complex multifaceted driving environments with a variety of competing and conflicting priorities. Further, the systems lens adopted enabled exploration of a range of contributory factors and revealed alternate likely pathways of accident causation and dependence within the management and regulation of beaches as roads. In closing we articulate a research agenda designed to enhance our understanding of the cultural, economic, and social implications of beach and off-road driving to improve safety and stakeholder coordination.