House Rules: Severe Injury, Dying, and Death

PHILOSOPHY OF HIT POINTS

Normal reductions in Hit Points are not translations of actual bodily injury with each hit. If a character has more than half of his normal HPs, he likely has not been hit at all. Instead, he has been using exceptional effort and skill to turn would-be hits into near misses.

From half total HPs down to 10 HPs, the character may be getting scuffed up a little bit here and there, maybe has been hit with a glancing blow or two, but is soldiering on through minor injury and increasing exertion.

In the single digit hit point range, a character is assumed to be enduring some actual bodily harm—cuts and stabs that are bleeding to some degree and will likely leave scars, bludgeon hits that have caused real tissue damage, all increasingly severe as the character approaches 0 HP.

When a character moves to zero HP (or below), the final event that caused the damage should be envisioned as the hit that "got through." That specific injury is now a threat on the character’s life—the knife stab that sinks between two ribs in the side, a mace striking hard against the skull, an arrow piercing through armor and into the abdomen, a force explosion that causes internal bleeding. It is a bad injury that may end up being the death of the character, but it has yet to be determined just how bad the injury is. The final result will be determined by the Severe Injury, Dying, and Death House Rules, detailed by sub-section below.

The Zero HP State:

The Character is on the ropes, severely busted up, but actually not dying. Characters are still operational at 0 Hit Points, but they suffer 3 Levels of Exhaustion and cannot take Reactions.

A character in the Zero HP State can no longer regain HP via Hit Dice rolls until he completes a Long Rest. If a character in the Zero HP State is able to gain HPs by way of a medical treatment or the rare magical healing, their shift to 1 HP or above will be delayed until they complete a Short Rest.

Some men can press on beyond normal levels of endurance, defying the effects of injury that would kill the average man. Characters of exceptional Constitution can continue to operate in their "Zero HP State" for a number of Negative Hit Points equal to the amount of their CON modifier.

In the Throes of Death:

Death Saves (as described in normal D&D 5e rules) will only begin when a character passes the Zero HP State, and proceeds into either Negative HPs or beyond the Negative HPs allowed by their CON modifier.

If a character starts his turn in a round with 3 Death Marks and he is already unconscious (was not able to Keep Fighting While Dying, see below), then he dies. If the character starts his turn in the round with 3 Death Marks, but he did successfully save to Keep Fighting While Dying, then he can continue to fight or act until the end of the combat encounter or 1d3 minutes, whichever comes first. At that time, the character inevitably dies, no matter what healing or treatment effects are delivered to him in the meantime.

If a character starts his Turn with 3 Stabilization Marks, he transitions back to 0 HPs (and into the Zero HP State). He may still be debilitated for a time (see Recovery below), but he is no longer in the throes of death.

Keep Fighting While Dying:

No matter what the results of the Death Saves each round, a character can make a CON save to continue to operate in the "Zero HP state" even though they are still at risk of dying and must continue to make Death Saves as necessary.

The DC to Keep Fighting While Dying is 5 if the character has not yet endured a Failed Death Save or "Death Mark".

The DC increases to 10 for 1 "Death Mark",

DC 15 for 2 "Death Marks", and

DC 20 for 3 "Death Marks".

Recovery after a Brush with Death:

If a Character ever has to make Death Saves, his recovery time will be adjusted from normal recovery rules.

If a Character makes all consecutive Stabilization Marks and tallies no Death Marks, he can begin to recover normally after 1 day of rest.

If a Character endured 1 Death Mark, he must rest for 3 days before normal recovery can begin.

If a Character endured 2 Death Marks, he must rest for 1 week before normal recovery can begin.

During these times of rest, a character gains 1 HP per day but still operates in the Zero HP State, due to the enduring effects of the injuries suffered during the near-death event.

Medical Treatment and Trauma Management:

When someone (referred to as "the medic") attempts to save a dying character ("the patient") with the use of medicine, first aid, or any other life-saving techniques, they must make a DC 5 Medicine skill check. This DC is increased by 5 for each Death Mark on the patient. (Which results in DC 20 on their last round before death.)

This skill check can be made with one of two objectives:
1. The medic can fight to repair the damage itself by removing a Death Mark, or
2. The medic can fight to restore body function by adding a Stabilization Mark.

If the medic rolls 20, the objective is double-effective. (Removing 2 Death Mark or adding 2 Stabilization Marks.)

If the medic rolls 1, the opposite happens. (Adding a Death Mark, or removing 1 Stabilization Mark.)

If the medic causes the patient to gain a Death Mark when they are already at 3, the patient dies instantly by the medic’s hand.