Hardcore Injuries
This is a work-in-progress optional rule. It is intended to add gritty realism to combat. See simple injuries for a simpler variant.
When damage reduces you to 0 hit points, or when you take damage while you have 0 hit points, make a Constitution saving throw. The DC is equal to the excess damage you took (excess damage = total damage - your hit points before taking damage). On a failed save, you suffer a lasting injury randomly determined by the amount and type of excess damage you took, as shown on the Injuries by Damage table below. If the damage comprised multiple damage types, you only suffer one injury, chosen randomly from the possible injuries.
Injuries by Damage
| Damage Type | 1+ Damage (Tier 1) | 15+ Damage (Tier 2) | 30+ Damage (Tier 3) | 45+ Damage (Tier 4) |
|---|---|---|---|---|
| Bludgeoning | Concussion, limb damage | Broken neck, destroyed limb | — | Crushed skull |
| Piercing | Eye damage, organ damage | Destroyed limb | Disembowelment | — |
| Slashing | Ear damage, limb damage | Destroyed limb | Disembowelment | Decapitation |
| Acid | Eye damage, facial scarring | Third-degree burn | Fourth-degree burn | — |
| Cold | Limb damage | Third-degree burn | Fourth-degree burn | — |
| Fire | Facial scarring, limb damage | Battleshock, third-degree burn | Fourth-degree burn | — |
| Force | Concussion, organ damage | Coma | — | Soul damage |
| Lightning | Limb damage, organ damage | Battleshock, third-degree burn | Stopped heart | — |
| Necrotic | Limb damage, organ damage | Destroyed limb | Total organ failure | Soul damage |
| Psychic | Concussion | Coma | — | Soul damage |
| Poison | Organ damage | Destroyed limb | Total organ failure | — |
| Radiant | Eye damage | Third-degree burn | Fourth-degree burn | Soul damage |
| Thunder | Concussion, ear damage | Battleshock | Stopped heart | — |
For example, suppose Joshua has 14 hit points and a paladin smites him, dealing 12 slashing and 18 radiant damage. He is reduced to 0 hit points with 16 excess slashing and radiant damage; the exact amounts of each damage type do not matter. Joshua must succeed on a DC 16 Constitution saving throw or else sustain a random injury. The possible injuries are ear damage, limb damage, or destroyed limb from slashing; or eye damage or third-degree burn from radiant.
Saving Throws
If an injury forces you to make a saving throw, the DC is equal to the amount of excess damage that caused the injury.
Healing an Injury
If you receive magical healing on a single turn equal to or exceeding the excess damage that caused an injury, the injury is healed. If a part of your body is out of place, it must be returned to its proper location first.
Other effects that heal wounds or injuries function as normal and can heal lasting injuries.
Tier 1 Injuries
"You'll get over it."
Concussion. You have disadvantage on Intelligence checks and Constitution saving throws made to maintain concentration.
Ear Damage. You are deaf in one ear, chosen randomly. You have disadvantage on sound-based Perception checks. If you sustain this injury on all of your ears, you are deafened.
Eye Damage. You are blind in one eye, chosen randomly. You have disadvantage on sight-based Perception checks. If you sustain this injury on all of your eyes, you are blind.
Facial Scarring. You have disadvantage on Persuasion checks and advantage on Intimidation checks while the scar shows. You do not gain this benefit against a creature that is immune to fear or that has advantage on saving throws against fear.
Limb Damage. One of your limbs, randomly determined, is seriously wounded. You have disadvantage on any attack roll or ability check that uses that limb. If the limb is a leg, your walking speed is halved. If the limb is a wing, you lose the ability to fly.
Organ Damage. At the end of each minute after sustaining this injury, you must succeed on a Constitution saving throw or become poisoned.
Tier 2 Injuries
"You may die."
Battleshock. Each time you sense someone take damage of the type that inflicted this injury, you must succeed on a Wisdom saving throw or become paralyzed until the end of your next turn.
Broken Neck. You can't move your body below your neck, causing the following effects:
- You can't move or take any action that requires the use of your body below your neck.
- You drop whatever you're holding and fall prone.
- You automatically fail Strength and Dexterity saving throws.
- Attack rolls against you have advantage.
- Any attack that hits you is a critical hit if the attacker is within 5 feet of you.
Coma. You fall unconscious and can't wake up.
Destroyed Limb. One of your limbs, randomly determined, is severed or otherwise rendered unusable. You can't use that limb for any attack roll or ability check. If the limb is a leg, your walking speed is 0. If the limb is a wing, you lose the ability to fly. If you have no usable arms, you have disadvantage on Strength and Dexterity saving throws. If you have no usable limbs at all, you automatically fail Strength and Dexterity saving throws.
Third-Degree Burn. You are vulnerable to acid, cold, fire, necrotic, and radiant damage.
Tier 3 Injuries
"You will die."
Disembowelment. Your organs fall out of your body. You take 1 damage at the start of each of your turns, and if you travel more than 5 feet on a turn, you die.
Fourth-Degree Burn. Your skin sloughs off, exposing damaged muscle. You are vulnerable to all damage except psychic and take 1 damage at the start of each of your turns.
Stopped Heart. You immediately begin suffocating. This injury ends if you take lightning damage.
Total Organ Failure. At the start of each of your turns, you become poisoned and take 1 damage.
Tier 4 Injuries
"You are dead."
Crushed Skull. Your skull and brain are flattened. You die.
Decapitation. You are relieved of your head. You die.
Soul Damage. Your very soul is damaged. You die and lose 1 level. If this would reduce your level to 0, your soul is permanently destroyed.