We analyzed 474 human casualties in wildlife–vehicle accidents (WVAs) that occurred between 2002 and 2022 in Lithuania, which is a small northern European country. The study revealed the escalating trend of WVAs, since 2018 surpassing other transport accidents, although the number of casualties per WVA was ca. 100 times lower compared to other transport accidents. Moose was the primary contributor, responsible for 66.7% of fatalities and 47.2% of injuries, despite much lower species abundance compared to roe deer, which is the main species involved in WVAs without human casualties. Temporal patterns highlighted seasonal, daily, and hourly variations, with the majority of casualties occurring during dusk or dawn in May and September, on weekends, and between 20:00 and 22:00. Spatially, main roads with high traffic density exhibited the highest casualties per unit length. Most casualties occurred after hitting an animal directly with cars and motorcycles being most vulnerable vehicles. The effectiveness of WVA prevention measures was inconclusive: 9.5% of fatalities and 1.4% of injuries were registered in the area of the warning sign, and 10.4% of all casualties occurred on fenced road segments. These findings suggest the need for a critical evaluation of the current prevention strategies in reducing human casualties associated with WVAs.