Objective Crashes involving agricultural vehicles (AVs) on public roads are an increasing road safety problem. We aim to analyze developments in the appearance and severity of these accidents, to identify influencing factors and to draw lessons for possible interventions for accident prevention within the context of modern mechanized agriculture. Methods To analyze developments in the appearance of accidents we use a subset of accidents with AVs involved on public roads in the Netherlands aggregated per year for 1987-2010. To identify and explore preventive measures we use an in-depth study of the Dutch Safety Board. With a study of international literature we put our findings in a wider context. Results During this time span, Dutch annual averages show 15 registered fatal accidents involving AVs, 93 with hospitalization and 137 with slight injuries. For non-fatal accidents, the numbers are decreasing over time. This decrease is proportionate to the reduction in the total number of traffic victims. For fatalities, however, the number is stable, increasing its proportion in all traffic fatalities from 1% in 1987 to 2% in 2010. Related to the number of inhabitants, this number is 2 times the value in the UK and 3 times the value in the USA. Influencing factors can be related to the three road system components (AV, driver, and infrastructure). Weak points for AVs are the view from the driver's seat, visibility at night, permitted vehicle width and crash aggressivity (large kinetic energy of the AV) that is transferred to other road users in case of a collision. Important factors identified for the driver are poor risk perception and high risk acceptance, in combination with speeding, dysfunctional use such as the use of AV's as modes of transport to and from school, and driving on public roads without protecting or removing protruding and sharp components. For infrastructure, the focus is on road design and separation of AVs from other motor vehicles. Lessons to be learned follow from these accident factors. For AV drivers, a driver's training focusing on driving behavior in the presence of vulnerable road users and concluding with an examination is advised. For vehicle safety, actual practice in the Netherlands is inadequate for control of proper maintenance. Some permanent requirements for the AV are insufficiently specific (view) or effective (lighting), and too generous (width). For infrastructure a wide range of measures is available. Conclusions A targeted approach to all road system components is urgently needed to avoid a further worsening of existing problems and to reduce the above proportional role of AVs in road danger.