Injuries and Wounds in Dungeons and Dragons
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All of my players enjoy epic high fantasy but they also enjoy playing heroes that get knocked around a bit. When describing their idea of a good campaign a word I frequently hear them use is “gritty”. Adventures that bring the heroes right up to the edge of failure or have them overcoming tremendous odds seem to be the ones they enjoy most. One of the things my players have requested from me to help them feel this “grittyness” is incorporating some sort of injury or wound mechanic in our Dungeons & Dragons campaign.
Although I’m inherently “anti house-rule” I agreed to give their request some thought. I started by asking the players what types of things made them feel gritty. Some of the answers I received included:
- Being low on healing surges and unable to rest
- Racing against time / being under the gun
- No longer having any daily powers or daily magic item uses
One response in particular caught my attention. The player of the party rogue said he felt that gritty feeling most when his character was suffering from a disease, in this case blinding sickness. In particular he said he liked having a condition that was hanging over him and could become better or worse over the course of days, not turns.
I thought for a while on how D&D deals with diseases. At their core diseases are simply conditions that weaken or inhibit a character and may improve or worsen over the course of days. This seemed like the perfect model for an injury, something that could happen to a character and take a while to recover from. With that in mind I set about creating “injuries” for my home campaign. In essence this system simply expands on the Dungeons & Dragons definition of the word “disease” to include any condition which lingers with a character, including injuries.
The Injury Mechanic
Our current play-test model for injury works as follows:
Step 1: After an encounter in which a character suffers a potential injury he makes a saving throw. Like diseases, on a failed save the character becomes injured. What constitutes a potential injury? We are experimenting with the following:
- Whenever a character has been “dying” during the encounter he must make an injury save afterward. If he failed a death save he has a -2 penalty to the injury save. If he failed two death saves the penalty increases to -5.
- I’ve designed certain traps that may cause injury. In one example a bear-style trap does less hit point damage but if a character takes damage from it he must make a saving throw to determine if he suffers a leg injury at the encounter’s end.
- We haven’t tried this yet but we are thinking about including possible injuries if a character suffered a critical hit during the encounter.
Regardless of what constituted the need for the injury save we simply keep track of what kind of attack did the damage that caused the character to be dying. Currently we base this on damage type; acid, cold, fire, force, lightning, necrotic, poison, psychic, radiant, and thunder, or for untyped damage we base it on where the character was hit. This is usually determined by whatever seems appropriate or the nature of the thing attacking.
Step 2: Once a character suffers from an injury the process for either recovering or getting worse is exactly like the process used for diseases. After each extended rest the character makes an Endurance check (or an ally can use a Heal check) to determine if the injury improves or worsens. Where this differs from a disease is the DC’s for this check. Instead of each kind of injury having its own DC’s and a “level of injury”, all injuries are based on the receiving character’s level. My rationale is that once injured it no longer matters what level you are; a 2nd level character’s broken arm is just as tough to recover from as a 15th level character’s.
Use the following chart to determine if the character’s injury improves, worsens, or maintains:
Level Improve Maintain Worsen
1st – 3rd DC 15 DC 10 9 or less
4th – 6th DC 17 DC 12 11 or less
7th – 9th DC 19 DC 14 13 or less
10th – 12th DC 21 DC 16 15 or less
13th – 15th DC 23 DC 18 17 or less
16th – 18th DC 25 DC 20 19 or less
19th – 21st DC 27 DC 22 21 or less
22nd – 24th DC 29 DC 24 23 or less
25th – 27th DC 31 DC 26 25 or less
28th – 30th DC 33 DC 28 27 or less
In the following examples I have listed the injury track from top to bottom, with the uppermost entry being Recovered (same as Cured for diseases) down to Wounded (same as Final Stage for a disease). As a final note I also have redefined the Cure Disease ritual to include Curing injuries and wounds.
Sample Injuries
Arm / Hand Injury
Recovered
Improvement: Target regains 1 of the lost healing surges and takes a -1 penalty to all attack rolls.
Initial Effect: Target takes a -2 penalty to all attack rolls and loses 2 healing surges that cannot be regained.
Wounded: While bloodied the target is weakened.
Leg / Foot Injury
Recovered
Improvement: The target’s speed is reduced by 1 and regains 1 of the lost healing surges.
Initial Effect: The target’s speed is reduced by 2 and loses 2 healing surges that cannot be regained until recovered.
Wounded: The target is slowed. Each time the target becomes bloodied it falls prone.
Head Injury
Recovered
Improvement: The target regains 1 of the lost healing surges and suffers a -1 penalty to Perception checks.
Initial Effect: The target loses 2 healing surges and suffers a -2 penalty to Perception checks. Each time the target becomes bloodied it is dazed (save ends).
Worsen: While bloodied the target is dazed.
Wounded: The target is dazed.
Body Injury
Recovered
Improvement: The target regains 1 of the lost healing surges and no longer suffers ongoing damage.
Initial Effect: The target loses 2 healing surges that he cannot regain until recovered. Each time the target becomes bloodied it takes ongoing [5 heroic / 10 paragon / 15 epic] damage (save ends).
Wounded: Each time the target becomes bloodied it takes ongoing [15 heroic / 20 paragon / 25 epic] damage (save ends). While bloodied the target is dazed.
Acid, Cold, Fire, Force, Lightning, Necrotic, Poison, Psychic, Radiant, or Thunder Injury
Recovered
Improvement: The target regains 1 of the lost healing surges and [damage type] attacks no longer receive a bonus to hit.
Initial Effect: The target loses 2 healing surges that he cannot regain, and any [damage type] attack against the target receives a +2 bonus to the attack roll.
Wounded: The target gains vulnerability [5 heroic / 10 paragon / 15 epic] to [damage type].
My home group is still experimenting with these and I would love feedback from anyone who tries it out in their home games. Let me know what you think.





January 30, 2009 at 9:55 am
That definitely makes things more gritty. It could alter the campaign as well. Say for instance your Paladin’s left hand gets damaged to the point that he cannot wield his large shield until it is healed. Or your Wizard damages his eyes to where his vision is extremely poor (cannot see beyond 5 squares). Or your thief severely hurts a foot and has his movement cut in half, and he is unable to shift in combat. Those are some pretty bad-ass penalties.
I definitely think there is a time and place for these things. You just have to kind of “clear” it with the players first. You don’t want to maim the party Cleric in and opening battle and then go, “Oh, by the way, I added some nasty injuries. Like that one you just got Cleric-boy. Ouch…”
January 30, 2009 at 10:11 am
I really like what you’ve done here. I have been thinking of ways to introduce levels of grittiness into my game, and the above ideas have two things going for them:
1) They model an existing mechanic, in that they operate similarly to diseases.
2) They do not seem so harsh; they happen when you are brought to 0 hit points or from a very specific type of trap . . .etc. The circumstances that bring them into play seem fair.
I will likely introduce these rules into my game, as well.
The Last Rogue’s last blog post..Sneak Attack #1 (The Marodieves)
January 30, 2009 at 10:11 am
Agreed. I think the rule of thumb should probally be to use injuries as frequently as you might use diseases. If you follow that model it should keep the injury concept in balance with the rest of the game.
John Lewis’s last blog post..Injuries and Wounds in Dungeons and Dragons
January 30, 2009 at 4:11 pm
Interesting take on injuries.
I would avoid inflicting one as a result of a critical hit, though, unless you’re planning on using “normal damage plus possible injury” instead of “maximum damage.” I think “maximum damage plus possible injury” is just a little too much for something that will happen on 1 in 20 attack rolls — which could easily be once per fight for the party’s fighter or paladin, if they’re doing their job.
January 30, 2009 at 4:35 pm
I agree completely. In addition I’ve noticed that with 4E having more monsters and NPC’s on the table means that the DM is rolling more attacks and subsequently more crits are being rolled.
John Lewis’s last blog post..Injuries and Wounds in Dungeons and Dragons
January 31, 2009 at 1:38 am
This is brilliant! We had a very good session last night, in part because both the cleric and the wizard were down to 4 and 1 hp respectively, 0 healingsurges. Instead of resting at the end of the last session, they pressed on, meaning that they reached their fifth milestone at the end and I had them make endurance checks because they were up fighting, climbing, walking and rowing over underground seas for nearly two days straight.
I appreciate that D&D isn’t about realism, but it doesn’t really emulate the wounded hero being dragged away by his comrades. Either you’re unconscious or you’re fine. Your suggestions seems to add some dramatic flair without being too cumbersome to implement or unsettling the game balance. I’ll try them out and let you know!
Jens Alm’s last blog post..The Second Dwarven Gate, An Encounter And A Skill Challenge
January 31, 2009 at 6:55 am
Reusing the disease track for injury is an awesome idea. Well done. It would be neat to know what kind of injury your character has, but with this system you wouldn’t until the injury had healed, I guess. If you recover in three days, for example, you can’t call it a broken arm. I’d also like to see a severing mechanic. And, a mechanic for grim wounds to foes.
Johnn Four’s last blog post..The Undead Are Coming!! A reply to Johnn
January 31, 2009 at 6:55 am
BTW, what plugin are you using for the Stumble button?
January 31, 2009 at 9:17 am
Johnn, I think I got it at this site.
http://www.stumbleupon.com/buttons.php?pgtype=blog
I had to make some modifications to it so it would show up in each of the posts properly, but I eventually got it to work how I wanted it.
Try that out and if you still can’t get it to work, maybe I could slice up the code to do it for you.
January 31, 2009 at 9:19 am
And to John, the stuff you are writing is getting more bad-ass and bad-ass. I know you love D&D and all, but when are you going to create your own game world and game system?! When do I get to play it?
January 31, 2009 at 3:29 pm
@Samuel: thanks! It’s hooked up now.
Johnn Four’s last blog post..The Undead Are Coming!! A reply to Johnn
March 9, 2009 at 8:07 am
This looks real cool! I JUST started playing D&D, my first ever real game was last night (we played for about 5 hours) and the DM was inexperienced… and so rolling for attacks was sometimes boring, or a critical was uneventful. This makes things way, way more interesting!
Beurre’s last blog post..Weird
March 31, 2009 at 8:31 pm
Perfect! this is exactly what I thought when I saw how 4e handles diseases but I never worked on it. I will definitely put this house rule to use in a future session.
I’ll let you know how it goes.
kaeosdad’s last blog post..Eldritch Blaaaast!
May 12, 2010 at 9:23 am
I’ve started to do something similar with a Pathfinder (Pathfinder is Paizo’s version of DnD 3.5 OGL) campaign that I have started with a group. I wanted to include some grit but also allow the player’s the freedom to choose or reject the grit as they saw fit. I thus used the Fate/Starblazers damage system as the basis for coming up with this house rule. We are still experimenting with it and seeing how people feel on it.
House Rule – Walking Wounded
Reason – To allow players a chance to get back up and get into a fight if they are knocked to negative hit points without needing to resort to divine healing.
Rule – Walking Wounded
1> The player gets back up or keeps going despite their injuries. In movies or stories this would be the hero that gets back up but has a limp or an injured shoulder.
2> Each of the three options can only be used once but they don’t need to be taken in order. The three options are ranked minor, major, and severe. Severe is the only choice to take if a character suffers enough damage that would exceed their negative threshold (negative hit points exceeds their constitution) or fail their save verses massive damage. While each of the penalties has a name it is only a suggestion and a player is free to describe the injury as they like as long as the penalty is the same. A sprained arm injury could be described by a player as a scratched eye but the game effect would be the same.
3> A player has up to three melee rounds after suffering an injury to spend a standard action to use one of these options. A player may spend the standard action even if they are at negative hit points or in the case of the Severe even if they would be dead.
4> Minor Option – The player recovers 25% of their maximum hit points which are added to their current hit point total. The player selects to either suffer a sprained leg injury or a sprained arm injury. The sprain lasts for 1d3 days or until they receive a Remove Curse or greater similar healing.
A sprained leg injury make it impossible to Double Move, Run, or Charge. There is also a -5 modifier on skill checks that involve the legs like Balance Checks, Leaping, and Climbing.
A sprained arm injury imposes a -2 Modifier on To-Hit Rolls which require the arms and -1 Modifier to AC. There is a -2 Modifier to skills checks that involve both arms.
5> Major Option – The player recovers 50% of their maximum hit points which are added to their current hit point total. The player selects to either suffer a broken leg injury or a broken arm injury. The broken arm or leg lasts for 2d3 days or until they receive a Heal spell or greater healing.
A broken leg injury reduces speed by 50% and makes it impossible to Double Move, Run, or Charge. There is also a -10 modifier on skill checks that involve the legs like Balance Checks, Leaping, and Climbing.
A broken arm injury imposes a -4 Modifier on To-Hit Rolls which require the arms and -2 Modifier to AC. There is a -5 Modifier to skills checks that involve both arms.
6> Severe Option – The player recovers 75% of their maximum hit points which are added to their current hit point total unless they should be dead in which case it recovers 25% of their maximum hit points (hey, you’re alive). The player selects to either suffer a lost leg injury or a lost arm injury. The lost limb is permanent or until they receive a Regenerate or greater similar healing (a raise dead spell will not replace lost limbs). A character can learn to adapt to the injury by going through an entire character level with the injury.
A lost leg injury reduces speed by 50% and makes it impossible to Double Move, Run, or Charge. There is also a -10 modifier on skill checks that involve the legs like Balance Checks, Leaping, and Climbing. If the character adapts to the injury then they can again Double Move, Run, and charge with the lost leg. The skill modifer when adapted drops to -5.
A lost arm injury imposes a -4 Modifier on To-Hit Rolls which require the arms and -2 Modifier to AC. There is a -5 Modifier to skills checks that involve both arms. If the character adapts to the injury then they suffer a -2 Modifier to To-Hit rolls which require the arms and a -1 Modifier to AC. The modifier to skills involving the arms drops to -2.