The aim of this study was to aid the optimisation of future, vehicle based, pedestrian injury countermeasures. The German In-Depth Accident Study (GIDAS) database was queried for pedestrians impacted by the front of a passenger car or van. A total of 1030 cases from 1998 to 2008 were studied including 161 severely (AIS3+) injured pedestrians. Considering the severe injuries, the most frequent injury mechanisms were “leg-to-front end”, “head-to-windscreen area”, “chest-to-bonnet area”, and “chest-to-windscreen area”. For children, a “head-to-bonnet area” impact was the second most common source of injury. With safety systems targeting these five injury mechanisms, 73% (95% confidence interval [CI], 65–81%) of the severely injured pedestrians would be provided protection from all of their vehicle-induced severe injuries. Omitting the windscreen area, this figure is decreased to 44% (CI, 36–53%). Furthermore, 31% of the surviving pedestrians were estimated to sustain a permanent medical impairment at any level. For more severe impairment, head was the dominating body region. The study shows that when developing countermeasures for the windscreen area to mitigate head injuries, attention should be paid to the structural parts of the windscreen area with a special focus on brain injuries. Finally, the incidence and risk of severe injury were derived as functions of impact speed for different body regions and injury sources.