Rules: Wounds and Healing

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

House Rule Ideas

Players sustain wounds:

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

Upon receiving a wound, the character loses 1HD. For every even numbered wound the character receives (e.g. you already have 1 wound and are wounded again), they must make a DC 15 CON saving throw or sustain a random minor injury (As an alternative remove the "Bloodied" option and the DC15 CON save and give an injury anytime when taking a critical hit or going to 0 HP.):

1. Eye Injury - Disadvantage on Wisdom (Perception) checks that rely on sight and on ranged attack rolls until healed.
2. Arm or Hand Injury - You can no longer hold anything with two hands, and you can hold only a single object at a time.
3. Foot or Leg Injury - You speed on foot is halved.
4. Foot or Leg Injury (Limp) - Your speed on foot is reduced by 5 feet. You must make a DC 10 Dexterity saving throw after using the Dash action. If you fail the save, you fall prone.
5. Internal Injury - You suffer +1 level of Exhaustion.
6. Broken Ribs - Same as Internal Injury except that the save DC is 10.
7. Messy Wound - Your wound is repugnant and you have disadvantage on Charisma (Persuasion) checks (or other checks that rely on your appearance).
8. Festering Wound - Your hit point maximum is reduced by 1 every 24 hours the wound persists. If your hit point maximum drops to 0, you die.
9. Minor Scar - You receive a minor scar. The scar doesn't have any adverse effect.

As an alternative to one of the injuries listed above, maybe just give 1 level of Exhaustion?

A minor injury may be healed by taking a short or long rest, receiving healing (using hit dice or magical healing) and expending one use of a healing kit. Hit Dice are regained after taking a long rest, receiving healing (unless already fully healed) and expending one use of a healing kit. For example, a

Healer's Kit. This kit is a leather pouch containing bandages, salves, and splints. The kit has ten uses. As an action, you can expend one use of the kit to stabilize a creature that has 0 hit points, without needing to make a Wisdom (Medicine) check.

For example, Malik, a 6th fighter with 50 hit points receives a critical hit and suffers 1 wound. Malik loses a hit die and has 5 remaining. Later he suffers additional wounds which reduce him to less than half his hit point maximum (bloodied). He loses another hit die and has 4 remaining. In addition, he rolls a DC 15 CON save and fails and sustains an injury, gaining a Limp (foot speed reduced by 5 feet). The party takes a short rest, and Malik uses 2 Hit Dice for healing (leaving 1 remaining) and the cleric uses a healing kit on him. Malik no longer suffers from a Limp. Later the party takes a long rest and uses another use of a healing kit on Malik, which cures one wound. At the end of the rest, Malik regains 2 Hit Dice (6 minus 1 wound = 5 / 2 = 2 Hit Dice), and now has a total of 3. The party decides to take another long rest, once again using a healing kit and Malik loses his last wound and regains 3 Hit Dice.

5E Rules

Players Handbook:

Exhaustion:

Some special abilities and environmental hazards, such as starvation and the long-term effects of freezing or scorching temperatures, can lead to a special condition called exhaustion. Exhaustion is measured in six levels. An effect can give a creature one or more levels of exhaustion, as specified in the effect’s description.

Level & Effect

1. Disadvantage on ability checks
2. Speed halved
3. Disadvantage on attack rolls and saving throws
4. Hit point maximum halved
5. Speed reduced to 0
6. Death

If an already exhausted creature suffers another effect that causes exhaustion, its current level of exhaustion increases by the amount specified in the effect’s description.

A creature suffers the effect of its current level of exhaustion as well as all lower levels. For example, a creature suffering level 2 exhaustion has its speed halved and has disadvantage on ability checks.

An effect that removes exhaustion reduces its level as specified in the effect’s description, with all exhaustion effects ending if a creature’s exhaustion level is reduced below 1.

Finishing a long rest reduces a creature's exhaustion level by 1, provided that the creature has also ingested some food and drink.

Lingering Injuries Optional Rule

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 Optional Rule

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 Wounds 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.