Rules: Wounds and Healing

Notes and references for alternative rules to wounds, hit points, rest and healing

5E DMG Optional Rules

Lingering Injuries

The DMG page 272 suggests the possibility of lingering injuries upon:

• When it takes a critical hit.
• When it drops to 0 hit points but isn't killed outright
• When it fails a death saving throw by 5 or more

Listed Lingering Injuries of Interest (with my own thoughts added):

• Lose an Eye (requires regenerate) - Use injury instead, same listed penalty until healed.
• Lose an Arm or a Hand - Use injury instead, same listed penalty until healed.
• Lose a Foot or Leg - Use injury instead, same listed penalty until healed.
• Limp -
• Internal Injury -
• Broken Ribs -
• Horrible Scar - Use injury instead, same listed penalty until healed.
• Festering Wound -
• Minor Scar -

Massive Damage

When a creature takes damage from a single source equal or greater than half its hit point maximum, it must success on a DC 15 Constitution saving throw or suffer a random effect determined by a roll on the System Shock table.

Of the effects listed on the table, I would just use "The creature is stunned until the end of its next turn." instead of rolling.

Lingering Rules and Healing

Taken from a post on EN World: 5E Lingering Wounds Revamped

Suffer a Wound:

• On "Bloodied" (half hp)
• On receiving a critical hit
• On going to 0 HP (or taking damage at 0 hp)

A wound reduces your Max HD by 1. If your max HD is reduced to 0 and suffer another wound you gain a level of exhaustion that can only be removed by curing the wound.

All other game rules apply as well. Say you drop to 0hp with 0 HD remaining. You fall unconscious and gain a level of exhaustion.

Wounds can be healed (Max HD restored) at the rate of 1 wound per day of rest. Healing spells gain the ritual tag and when cast as a ritual, heal a number of wounds equal to the level of the spell slot used.

You could even drop the unconscious at 0HP rule, maybe impose disadvantage on everything instead, to completely get rid of "whack a mole"...the penalties for wounds are severe enough to encourage getting out of the fight. You could even introduce a severity level: Light wounds are the normal HP drain, Moderate wounds are one of the above conditions (crit, for example), Serious Wounds are two of the conditions (crit and bloodied, eg), and Critical Wounds are all three of the above (crit, bloodied, and 0 hp). Each wound takes a number of days of rest to drop by 1 severity (Critical wounds would completely heal in 3+2+1 = 6 days and would need a 3rd, 2nd,and 1st level spell slot healing ritual to be cured). Probably too granular for most.