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The optional rule on p. 272 of the DMG lists one of the triggers for Lingering Injuries as:

When [a creature] drops to 0 hit points but isn’t killed outright.

Because "but isn't killed outright" was included in the description, it suggests that a creature that is killed outright and then raised with Raise Dead, for instance, won't have to worry about the possibility of missing limbs, whereas one who didn't die straight away and later died from failed death saves won't be so lucky.

If I alter the optional rule to include creatures killed outright, what implications may that have with regard to those creatures being brought back with lingering injuries?

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1. RAW clarification: Doubly optional

While the whole Lingering Injuries section describes an optional rule, the list of situations which inflict them is also just a suggestion:

It's up to you to decide when to check for a lingering injury. A creature might sustain a lingering injury under the following circumstances: (DMG 272, emphasis mine)

So the RAW here is a resounding "I d'unno". If you, as a DM, feel that a situation warrants a roll on the table, you are entitled to ask for one. What you propose is not strictly an alteration to the rules presented.

2. Gameplay issues: Mostly harmless

This rule will only impact groups who can only access cheap resurrection methods. Obviously those who have no access to even revivify will see no difference. Those with access to casters capable of casting 7th level clerical spells also need not worry, as resurrection restores missing body parts and if you classify it as "healing magic", it will eliminate all lingering injuries. Even without that, chances are they also have access to regenerate or heal from the same caster, making curing the injuries an option.

Thus this will most likely come up between 5th and 8th or 10th level, depending on the availability of NPC casters. In most cases the difference will be in the amount of money necessary to get the character back in fighting shape.

Dropping to 0 HP from smaller injuries is way more frequent than being downed from massive damage or instakill effects, especially in this level range. I would not expect this issue to come up more often than once in two levels or so (ie. 2 or 3 times per campaign) unless you regularly put in traps that drop 16 ton weights on the PC-s. Add to this that many effects they can roll on the table are not that much of a bother to live with and you are looking at a mostly negligable change in play experience.

Also, you have to keep in mind that some effects that "kill outright" also specify the method by which that happens, like the spell desintegrate. There isn't much point in rolling for a missing leg when you practically have a missing body. In other cases you have to decide whether a lingering injury is a logical outcome of the effect, like with power word kill. Would it be reasonable to lose an arm from being hit by this spell? You have to decide in advance, which brings me to my next point:

3. Social issues: Be upfront

Calling for a roll during all forays to the wrong side of 1 HP sounds reasonable to me, but be sure your players also think so. What you need to keep in mind is to be transparent and consistent. Tell your players what your plans are regarding Lasting Injuries and discuss it with them. After that stick to those rules, for PC-s and NPC-s alike.

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    \$\begingroup\$ @NautArch Some results on the table specify "healing magic" as an effect that removes the injury. \$\endgroup\$ – Szega May 15 at 14:07
  • \$\begingroup\$ @NautArch Magical healing or regenerate can remove all of them. Only "festering wound" and "internal injury" can be healed without magic. \$\endgroup\$ – Szega May 15 at 14:43
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    \$\begingroup\$ @NautArch I meant that if you have access to both, you can cure any LI result (misunderstood you a bit). Anyway, with instakills being so rare, I do not expect any noticeable change in the prevalence of harder to cure injuries. You add ~10% more rolls on the table and only 6/20 need high lvl magic to cure (excluding "minor scar" that has no effect). \$\endgroup\$ – Szega May 15 at 14:52
  • \$\begingroup\$ A gameplay issue you may wish to address is that rolling on a table every time something dies takes time, which could prolong combats even more. And it is usually not very interesting that one dead goblin lost an eye and one had its ear cut off, etc. \$\endgroup\$ – Someone_Evil May 15 at 14:57
  • \$\begingroup\$ @Someone_Evil I presume common sense on the part of the DM. They are already expected to skip unimportant details. But I would consider rolling for enemies that are brought back from 0/death fair. Also, NPC-s are rarely revived, so the proposed changes don't have much of an impact. \$\endgroup\$ – Szega May 15 at 15:04
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No issues arise, and the importance of high-level magical healing increases.

A clarification on "how the optional rule's triggers work normally", is followed by "how the addition of your fourth trigger would impact resurrection."

The optional rule has three (recommended) triggers:

  1. When it takes a critical hit.
  2. When it drops to 0 hit points but isn't killed outright.
  3. When it fails a death saving throw by 5 or more.

Instant Death (PHB 197):

Massive damage can kill you instantly. When damage reduces you to 0 hit points and there is damage remaining, you die if the remaining damage equals or exceeds your hit point maximum.

In this case, you do not make a death-saving throw, and therefore you can't fail your death saving throw by 5 or more, do not roll on the table. Your hit points are dropped to 0, and you are killed outright, therefore trigger two does not apply, do not roll on the table. Your instant death is possibly caused by a critical hit, if this is due to a critical hit, then roll on the table.

If you include a fourth trigger that also enables a Lingering Injury by:

  1. When it dies.

Then the Lingering Injury may persist after you cast Raise Dead:

This spell also neutralizes any poisons and cures nonmagical diseases that affected the creature at the time it died. This spell doesn't, however, remove magical diseases, curses, or similar effects; if these aren't first removed prior to casting the spell, they take effect when the creature returns to life. The spell can't return an undead creature to life. This spell closes all mortal wounds, but it doesn't restore missing body parts. If the creature is lacking body parts or organs integral for its survival--its head, for instance--the spell automatically fails.

All mortal wounds are closed. Raise Dead is magical Healing (PHB 197) so it will remove the effects of Limp, Internal Injury, Broken Ribs, and Festering Wounds. If cast at 6th level or higher, then it will also remove the effects of Horrible Scar, and Minor Scar. No body parts are restored either way.

So if you are resurrected by magical healing, then you will remove the effects of Limp, Internal Injury, Broken Ribs, and Festering Wounds. If the method of resurrection is a 6th-level spell or higher, then it will also remove the effects of Horrible Scar, and Minor Scar.

Resurrection will also restore your missing body parts. True Resurrection will replace any damaged or missing body parts.

Spells such as Animate Dead are not magical healing. They are creation type effects, and thus will not remove any of the Lingering Injury effects.

The fourth trigger will make some of the conditions more impactful for characters that die, as you create options that introduce the potential for long-term injuries with this optional rule it appears to be in the line of that intended design. The importance of high-level magical healing increases.

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