Real, Bad, Injuries

When playing by these rules damage stacks up very quickly, making for an exceedingly deadly game – ideal for threatening characters of any level with low-CR creatures. Stronger creatures may have to be reduced in power to ensure that they do not kill PCs in one shot each. This system is best used in the first two tiers of play (through level 10), and especially suited for the first tier (through 4th level).

Using these rules in those tiers allows the GM to build dungeons that are challenging, without PCs having access to ‘dungeon-breaking’ spells and abilities like passwall or teleport. It is recommended that you limit your players’ access to material components for powerful, low-level healing spells such as revivify, thus allowing your players to use such a spell only once or twice in a given dungeon.

Most class features and rules remain the same as the core mechanics presented in the PHB, with the following exceptions.

Criticals, Damage, and Dying

When your character takes a critical hit or is reduced to 0 hp, you can elect to instead take an injury. These injuries represent persistent, severe problems that may require magical healing, or even be resistant to magical healing.

If you elect to take an injury when struck by a critical hit or reduced to 0 hp, you reduce the damage taken to 1 point, which cannot be reduced by any means.

If you elect to take an injury roll a d10 and refer to the table below for the result. Mark down the result of the d10 roll as well, and mark it on your character sheet. Should you take an injury in the future you roll a d10 and add your current injury level. So, for example, a character that rolls a 4 the first time they take an injury breaks their off-hand, and marks “4” on their character sheet. Should they take another injury they roll a d10 again for a result of 7, and add the previous number (4) for a result of 11. Should they take a third injury they’ll roll again and add 11, and so forth.

1. Minor Concussion. When you roll an ability check, attack roll, or saving throw roll a d6 as well and subtract it from your roll. Should this d6 result in a 6 you end this injury condition after the roll is resolved, but also immediately roll the d6 again and add it to your injury level. You do not take the penalties from your new injury level, it simply results in further injuries being substantially more dangerous. This effect can be ended early, without adding to your injury level, with a casting of lesser restoration.

2. Major Concussion. You are stunned. At the end of your turn, each turn, roll a d6. On a result of 5 or 6 you are no longer stunned, but add the result of the die roll to your injury level. You do not take the penalties from your new injury level, it simply results in further injuries being substantially more dangerous. This effect can be ended early, without adding to your injury level, with a casting of lesser restoration.

3. Fracture a limb (roll a d4. 1: non-dominant arm, 2: dominant arm, 3: left leg, 4: right leg). You roll Strength and Dexterity ability checks at Disadvantage if a hand is fractured, or reduce your speed by half if a leg was fractured. This effect lasts until you finish a long rest or with a casting of restoration.

4. Break a limb (roll a d4. 1: non-dominant arm, 2: dominant arm, 3: left leg, 4: right leg). You can no longer use that hand, if an arm is affected, or your speed is reduced to 5 ft. if a leg is affected. If your arm is affected you cannot use a two-handed weapon or may have to drop a shield or off-hand weapon, and Strength and Dexterity checks are made at Disadvantage. Spellcasters with a broken hand must roll a d20 when casting a spell with somatic components, and waste their action if the result is 10 or lower. This effect lasts until you receive a casting of restoration or similar.

5. Jaw fracture. You receive a minor concussion (as the first result on this table) and also slur your speech. Spellcasters with a broken jaw must roll a d20 when casting a spell with verbal components, and waste their action if the result is 10 or lower. This effect lasts until you receive a casting of lesser restoration or similar.

6. Skull fracture. You are stunned. At the beginning of each of your turns roll a d6. On a result of 4 to 6 you are not stunned until the start of your next turn. This effect lasts for 1 minute. At the end of the minute add 1d6 to your injury level. You do not take the penalties from your new injury level, it simply results in further injuries being substantially more dangerous. This effect can be ended early, without adding to your injury level, with a casting of restoration.

7. Broken ribs. When you roll an ability check, attack roll, or saving throw roll a d6 as well and subtract it from your roll. This effect can be ended with a casting of lesser restoration.

8. Limb loss (roll a d4. 1: non-dominant arm, 2: dominant arm, 3: left leg, 4: right leg). Your limb is crushed, paralyzed, or entirely severed. You can no longer use that hand, if an arm is affected, or your speed is reduced to 5 ft. if a leg is affected. If your arm is affected you cannot use a two-handed weapon or may have to drop a shield or off-hand weapon, and Strength and Dexterity checks are made at Disadvantage. Spellcasters with a missing hand must roll a d20 when casting a spell with somatic components, and waste their action if the result is 10 or lower. This effect lasts until you receive a casting of restoration or similar.

9. Eye loss. You have Disadvantage on attack rolls and sight-based ability checks (typically Perception or Investigation). Should you receive this result twice you are blind.

10. Brain damage. When you roll an ability check, attack roll, or saving throw roll a d6 as well and subtract it from your roll. Additionally, roll a d6 and add it to your injury level.

11. Torso trauma. Your chest is crushed, slashed open, or otherwise seriously hurt. You roll Strength and Dexterity ability checks and saving throws with Disadvantage and your Speed is reduced by 10 ft. to a minimum of 5 ft.

12. Broken everything. When you roll an ability check, attack roll, or saving throw roll a d6 as well and subtract it from your roll. You roll Strength and Dexterity ability checks and saving throws with Disadvantage and your Speed is reduced by 20 ft. to a minimum of 0 ft.

13. Pinata. You lose a limb (roll a d4. 1: non-dominant arm, 2: dominant arm, 3: left leg, 4: right leg). Your limb is crushed, paralyzed, or entirely severed. You can no longer use that hand, if an arm is affected, or your speed is reduced to 5 ft. if a leg is affected. If your arm is affected you cannot use a two-handed weapon or may have to drop a shield or off-hand weapon, and Strength and Dexterity checks are made at Disadvantage. Spellcasters with a missing hand must roll a d20 when casting a spell with somatic components, and waste their action if the result is 10 or lower. Additionally, you roll Strength and Dexterity ability checks and saving throws with Disadvantage and your Speed is reduced by 20 ft. to a minimum of 0 ft.

14. Reset. You reduce your injury count to 0, and immediately roll on this table twice again. These rolls are in sequence, so you will receive one injury, then roll again and add the previous roll to determine the previous injury. You can, potentially, receive this result again on your subsequent roll, in which case repeat this process.

15. Fatality. You roll Strength and Dexterity ability checks and saving throws with Disadvantage and your Speed is reduced by 20 ft. to a minimum of 5 ft. Further, you have only so long to live. You will die in 10 rounds unless targeted with a healing spell of 6th level or higher.

16. Fatality. You roll Strength and Dexterity ability checks and saving throws with Disadvantage and your Speed is reduced by 20 ft. to a minimum of 5 ft. Further, you have only so long to live. You will die in 8 rounds unless targeted with a healing spell of 6th level or higher.

17. Fatality. You roll Strength and Dexterity ability checks and saving throws with Disadvantage and your Speed is reduced by 20 ft. to a minimum of 5 ft. Further, you have only so long to live. You will die in 6 rounds unless targeted with a healing spell of 6th level or higher.

18. Fatality. You roll Strength and Dexterity ability checks and saving throws with Disadvantage and your Speed is reduced by 20 ft. to a minimum of 5 ft. Further, you have only so long to live. You will die in 4 rounds unless targeted with a healing spell of 6th level or higher.

19. Fatality. You roll Strength and Dexterity ability checks and saving throws with Disadvantage and your Speed is reduced by 20 ft. to a minimum of 5 ft. Further, you have only so long to live. You will die in 2 rounds unless targeted with a healing spell of 6th level or higher.

20. Death. You die, immediately.