Senna's third and final race of the 1994 season, the San Marino Grand Prix, was held on the "Autodromo Enzo e Dino Ferrari" circuit located in Imola, Italy. Imola had traditionally been considered the beginning of the F1 season proper, on European soil.
Senna, who did not finish the two opening races of the season, declared that this was where his season would start, with fourteen races, as opposed to sixteen, in which to win the title. Senna placed the car on pole for a then-record 65th and final time, but he was upset by events unfolding that race weekend. That weekend, Senna's feedback about the FW16 included comments about the car switching between oversteering and understeering and that the car's performance was generally worse instead of better after the engineers' latest adjustments.
During the afternoon qualifying session, Senna's compatriot and protégé Rubens Barrichello was involved in a serious accident when his Jordan became airborne at the Variante Bassa chicane (the last of the circuit) violently slamming into the tyres and fence. In the impact, Barrichello suffered a broken nose and arm; injuries that prevented him from competing in the race. Barrichello indicated that Senna was the first person he saw upon regaining consciousness.
The next day, Saturday, Austrian rookie driver Roland Ratzenberger was killed during qualifying in a devastating accident when the front wing broke on his Simtek-Ford while going flat out at the fast Villeneuve right-hander bend and into the concrete wall. A distraught Senna requested a track marshall to take him to the site of Ratzenberger's fatal crash. Senna was met by FIA's Medical Chief Professor Sid Watkins, who recalled that Senna was tearful, despite having only just met Ratzenberger the previous day. Professor Watkins suggested to Senna on that occasion to stop racing and go fishing (a hobby they both shared), to which Senna said he could not stop racing.
To obtain information about his injured colleagues that weekend, Senna climbed the fence of the Medical Centre after he inspected the crash site. Senna had commandeered an official's car to visit that site, yet the FIA chose not to take any formal disciplinary actions against Senna.
Senna spent his final morning making time to meet with fellow drivers to discuss the re-establishment of a drivers' group (i.e. Grand Prix Drivers' Association) in an attempt to increase safety in Formula One, because of that weekend's tragic events. As the most senior driver, Senna offered to take the role of leader, starting from the next race event in Monaco.
During the drivers' briefing, complaints were raised about the commercial gimmick of a Porsche 911 lead car for the warm-up lap. As this lap neared, Senna again queried the closeness of the Porsche and was jokingly told by his team's chief engineer, Patrick Head, that the 911 would remain close by, as per the preceding races. Instead, the Porsche was ordered to leave earlier, to Senna's content.
At the start of the Grand Prix race, Senna retained the lead from Schumacher but proceedings soon became interrupted by a huge accident on the start line, caused by JJ Lehto's Benetton-Ford stalling, and an unsighted Pedro Lamy ramming him in his Lotus-Mugen Honda at nearly full speed. A wheel was torn off the car and landed in the main grandstand, injuring eight fans and a police officer. The safety car – which was a sporty version of the Opel Vectra medium family sedan – was deployed and the drivers followed it for several laps. The Vectra's slow pace was later questioned because of the consequential drop in tyre pressures on the Formula One cars. In fact, under those safety car conditions, video footage shows Senna pulling alongside the Vectra, gesticulating to the Vectra driver, Max Angelelli, to increase his speed. On the restart (lap 6), Senna immediately set a quick pace with the third quickest lap of the race, followed by Schumacher. As Senna entered the high-speed Tamburello corner on lap 7, the car left the track at around 205 mph (330 km/h), hitting the concrete retaining wall at around 135 mph (217 km/h), after what telemetry showed to be an application of the brakes for around 2 seconds. The red flag was shown as a consequence of the accident. Within two minutes of crashing, Senna was extracted from his race car by Professor Sid Watkins and his medical team. Initial treatment took place by the side of the car, with Senna having a weak heartbeat and significant blood loss (approximately 4.5 liters). Because of Senna's poor neurological condition, Professor Watkins performed an on site tracheotomy and requested the immediate airlifting of Senna to Bologna's Maggiore Hospital, where he was declared dead hours later. Watkins later said that as soon as he saw Senna's fully dilated pupils, he knew that his brainstem was inactive and that he would not survive.
It is believed that the right suspension frame was sent stabbing back into the cockpit, striking Senna on the right side of his helmet, forcing his head back against the headrest and causing fatal skull fractures and brain injury. A piece of the upright attached to the wheel partially penetrated his helmet causing trauma to his forehead. In addition, it appeared that a jagged piece of the upright assembly, most likely a tie rod, penetrated the Bell helmet visor, which was a new, thinner version, above his right eye. Senna also suffered a burst temporal artery.
It was later revealed that, as medical staff examined Senna, a furled Austrian flag was found in his car—a flag that he had intended to raise in honour of Ratzenberger after the race.
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