To detect and explain changing trends in incidence, case fatality rates, and mortality for unintentional injuries in the Netherlands for the years 1950 through 1995. Using national registry data, the authors analyzed trends in traffic injuries, occupational injuries, and home and leisure injuries. Between 1950 and 1970, mortality from unintentional injuries rose, reflecting an increasing incidence of injuries. This was followed by a sharp decline in mortality due to a decreasing incidence combined with a rapidly falling case fatality rate. Starting in the second half of the 1980s, the decline in mortality leveled off as the incidence of several injury subclasses once again rose. The observed trends reflect several background factors, including economic fluctuations (influencing exposure), preventive measures (reducing injury risk and injury severity), and improvements in trauma care (lowering the severity-adjusted case fatality rate). Injury mortality can be reduced through measures that lower injury risk, injury severity, or severity-adjusted case fatality rates. Beginning in the mid-1980s, such compensatory mechanisms have fallen short in the Netherlands. New policies are needed despite the impressive reductions in mortality already reached.