Rules: Wounds and Healing

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

House Rule Ideas

A character may sustain a wound upon one the following events:

  • On "Bloodied" (half hp) = DC 10
  • On receiving a critical hit = DC 12
  • On going to 0 HP = DC 14
  • On taking damage after at 0hp = DC 16

When one of these events occur, a Constitution Saving Throw is made at the listed DC. If the save succeeds, there is no effect. If the saving throw fails, the character takes a wound and sustains a minor injury.

A wound results in the loss of 1 Hit Dice from the characters available pool and maximum and one minor injury:

  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 - You have disadvantage on Dexterity checks.
  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 permanent minor scar. The scar doesn't have any adverse effect, but still counts as an injury until it is treated.
  10. Minor Concussion - You receive disadvantage on any ability checks that use Wisdom or Intelligence.

A character that already has a minor injury and sustains a new one, will suffer +1 level of Exhaustion in addition to any other effects or penalties.

Healing Wounds and Injuries: An injury may be healed by taking a short a short or long rest and receiving healing (using either hit dice or magical healing) and expending one use of a healing kit.

Lost Maximum Hit Dice are recovered at a rate of 1 HD per long rest.

A minor injury may be healed by taking a short or long rest, receiving healing (using either hit dice or magical healing) and expending one use of a healing kit (lost HD are not recovered).

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.

Example

Malik, a 6th level fighter with 50 hit points and 6 Hit Dice available receives a critical hit, makes his DC12 CON saving throw and suffers no ill effect.

In the course of the battle, Malik suffers enough damage to become "bloodied" (has lost 25 or more hit points), and fails his DC10 CON saving throw. Malik loses one of his six hit dice. leaving his with a maximum of 5 and sustains a minor leg wound, gaining a limp which reduces his speed by 5 feet.

Later Malik takes a short rest. He only has 5 Hit Dice available and he uses 3 to heal and expends one use of a healing kit to treat his injury. Malik no longer has a limp and has 2 Hit Dice left and a maximum of 5.

In a second battle Malik gets unlucky and suffers a critical hit which "bloodies" him and he fails both the DC10 CON save for "bloodied" and the DC112 CON save for the critical hit. He loses the 2 Hit Dice he had remaining leaving zero and he now has a maximum of 3 Hit Dice. He sustains two injuries, a Messy Wound which gives him disadvantage on Charisma (Persuasion) checks, and as a second injury he gets an Internal Injury which causes +1 Level of Exhaustion. Because Malik already had an injury, he gains an additional level of exhaustion which give in a total of 2 levels so he is also suffering disadvantage on ability checks and his speed is halved.

The party takes another short rest. Malik no longer has any hit dice left for personal healing, and the party uses two healing spells and two uses of a med kit to treat his injuries. He is no longer suffering the injury penalties, but still has a maximum 3 Hit Dice and none remaining to use. Feeling better from being treated the party retreats to a safe place and takes a long rest. After the long rest, Malik regains all his lost hit points and only 1 Hit Dice (his 3 remaining divided by 2, round down), but his Hit Dice Maximum goes up by 1 and is now 4. The party decides to take an additional long rest. Malik regains 2 Hit Dice (4 divided by 2) and now has a total of 3, and his maximum is now 5. Yet another long rest would allow Malik to recover fully, he would regain his remaining 2 Hit Dice (5/2=2 plus the 3 he already had = 5 Hit Dice) and his maximum would return to his normal 6 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.