There has been considerable development of car design to reduce pedestrian injury severity and thus the role of the ground impact in causing severe head injury has come to the fore. A Madymo model is used to examine the relative severity of the road and vehicle impacts and the effect of pedestrian motion before impact. Results show head impact locations on the vehicle are predictable but their severity varies with pre-impact stance. In contrast, head-ground impact is highly variable. The ground stiffness results in high contact forces, but the delta V for ground impact is less severe than the vehicle impacts, showing a higher momentum change in the latter.