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I was running a game a few weeks ago. In short, during combat the thief and the warlock were both knocked unconscious. Each were brought back by the cleric with healing word and cure wounds. New round, both get knocked out again. Repeat this for 3 rounds until the barbarian manages to end combat. The party loots the camp and wants to keep travelling.

At this point, I was thinking to myself, "I feel like taking that kind of beating should mean something." But at the time, I did not remember if there was a rule for that.

Are there any rules that would give some sort of penalty to the PCs in this situation?

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    \$\begingroup\$ We're you having the occupants attack the thief or barbarian while unconscious? Seeing the cleric bring them back from the brink could cause the combatants to focus their attention on finishing off one of the opponents fully (since taking damage while unconscious causes a failed death saving throw, and a critical hit, which every melee attack is vs an unconscious character does two death saving throw failures) \$\endgroup\$ – David Coffron Oct 27 at 17:56
  • \$\begingroup\$ @DavidCoffron - From what I can remember, the occupants were trying to off the players. Even with multi attacks from the leader, 1st hit knocked them out, and if the 2nd hit, 2 failed saves. Then the cleric heals them. \$\endgroup\$ – Kentrol Oct 27 at 18:06
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    \$\begingroup\$ Did the one cleric cast both cure wounds and healing word in one turn? \$\endgroup\$ – Ruse Oct 27 at 21:46
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    \$\begingroup\$ See also the Pathfinder 2 rules, as the ping-pong dying-not-dying effect of 5E's combat hp was something they wanted to fix. Quickly: when you go from dying to not-dying you gain a Wounded 1 condition (if you already had Wounded, the value goes up by 1). When you drop to 0 hp, you gain the Dying condition, with a value of 1 + your Wounded value (So Dying 1 -> Wounded 1 -> Dying 2 -> Wounded 2...). If you went down to a critical hit, add an additional 1. When you hit Dying 4, you're dead Jim. (I may be off slightly, I haven't looked at it recently, but this gives you an idea). \$\endgroup\$ – Draco18s Oct 28 at 14:22
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Optional rule: Lingering Injury

There are no rules in the PHB limiting how often a PC can get up after being knocked to 0 HP. For DMs who don't like there being few consequences for dropping to 0 HP, in the DMG on page 272 there is an optional rule for lingering injuries that covers any PC who:

  • Receives a critical hit
  • Drops to 0 HP but is not killed out right
  • Fails a death saving throw by 5 or more.

Experience with this rule

I've had two DMs use this rule, and each of them chose after a time to get rid of "receives a critical hit" triggering criteria. Why? Because the PC's receive many attack rolls against them; eventually everyone ends up with a lingering injury. All that the basic critical hit does in this edition is increase damage (HP reduction) done on that attack.

There are 9 choices, determined by a d20 roll. If you do the math a bit, as one of my DMs did, you realize that by level 11 everyone in the party will be wearing an eyepatch and be short of an eye, at the least, and will likely have multiple other performance inhibiting effects. And that's without having bad luck. You can be blind by level 3 with a little bad luck.

There is already a penalty at 0 HP: the unconscious condition

If enemies make attacks on unconscious PCs, it already causes two failed death saves, since the attack is automatically a critical hit if it is done by a creature within 5 feet.

  • The creature automatically fails Strength and Dexterity saving throws.
  • Attack rolls against the creature have advantage.
  • Any attack that hits the creature is a critical hit if the attacker is within 5 feet of the creature.

When you are at 0 HP, a critical hit = two failed death saving throws.

Damage at 0 Hit Points. If you take any damage while you have 0 hit points, you suffer a death saving throw failure. If the damage is from a critical hit, you suffer two failures instead. If the damage equals or exceeds your hit point maximum, you suffer instant death. (Chapter 9, Combat)

Recommendation(if you want to apply this rule)

Apply this lingering injury effect after the battle if the PC dropped to 0 HP but wasn't killed outright, and / or missed a death saving throw by 5 or more. (Since you only roll those when you drop to 0 HP anyway, that is a supplement to the "drop to 0 HP" criterion). One of my DMs allowed the lingering injury to be alleviated by receipt of magical healing.

  • Caveat: In both cases I noted above the DM"s first floated the idea to the players and got consensus - they didn't just add it on. I suggest that you do likewise if you think it's a good optional rule. Experienced players (we all were) are less likely to find this change to burdensome. @dsollen made a good point in a comment about the negative impact on the PC often being unpallatable to less experienced players and new players. If they get dropped to 0 HP a lot, they may be struggling tactically and adding further negative impact to 0 HP may not improve their play experience.

Thoughts on how to accept this game feature

  1. Mechanically, this game offers a way for HP at 0 to force a decision: to expend a resource or not. (Example: do I burn a spell slot on Healing Word to get Grax the Barbarian back on his feet, or do I {do something else}?
  2. Lying around dead while everyone else is fighting is rarely fun for a player.
  3. Having a way to get your ally back up and back into the fight promotes and rewards teamwork. The core conceit of this game is that it is a party, a team, of characters with different talents and gifts that are out adventuring to achieve {X objective}. Why remove a way for one team mate to get them back into play? That way the player gets to take a turn ...

"I feel like taking that kind of beating should mean something."

Is the problem that combat does not feel dangerous or deadly enough to your group?

Optional Rule: System Shock

In a related massive damage rule meant to emphasize "Combat is Dangerous and Lethal!" on DMG page 273, there is a system shock table that forces a Constitution save based on whether or not a PC took over half of their damage in one blow. This one penalizes PCs who do not pump Constitution, and those unlucky enough to be hit with a natural 20 roll by an enemy who then does double damage. If you apply this to monsters as well, to be fair, combat can change quite a bit.

I dropped this one after two sessions; it slowed combat down, and "stunned" (See Conditions, Appendix A) is a powerful condition (for the creature's opponents) to have applied to any creature. Most cases of stun require magic to apply, or require a Monk.

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    \$\begingroup\$ I feel as though the system shock part of your answer is irrelevant, because the question is about being knocked to 0 hp multiple times, not about massive damage in one blow. Great answer nonetheless, especially the part where you describe your experience with the lingering injury rules \$\endgroup\$ – Ruse Oct 27 at 21:43
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    \$\begingroup\$ @Ruse I added that as another example of an alternate rule (and it's right next to the lingering injuries rule) that increases the lethality of combat, which adding consequences to dropping to 0 HP also does. The question asker seems to feel that the penalty for droppiung to 0 HP isn't enough ... but maybe I need to put that reference into a coda and not in the body of the answer? \$\endgroup\$ – KorvinStarmast Oct 28 at 11:43
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    \$\begingroup\$ I will upvote this since it is providing the sort of rule recommended, but personally I wouldn't advise using either rule. If the players are struggling this much (assuming this is representative of their normal play and not a one bad fight where something went wrong) then the players are likely inexperienced and struggling in the game. Adding more penalties to further handicap them seems like it's going to make an already struggling team do worse, and may very well turn them off of the game entirely. \$\endgroup\$ – dsollen Oct 28 at 14:24
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    \$\begingroup\$ @mbrig One of the DMs toyed with (for my battlemaster) reduced movement from 30' to 20' until I got a long rest. He didn't find that to be severe enough, though ... I might add that example later, even though it didn't work out. \$\endgroup\$ – KorvinStarmast Oct 28 at 18:50
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    \$\begingroup\$ @Blueriver My character in a dormant campaign has one of those lingering injuries that is a scar. But it has an effect. Persuasion checks at disadvantage, intimidation checks at advantage. (Beats being blind in one eye, that's for sure) \$\endgroup\$ – KorvinStarmast Oct 28 at 22:09
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There are the Lingering Injuries optional rule

In the standard rules there are no lingering effects from damage, including that which reduces a creature to 0 hit points (other than the obvious lingering effect of death). However, on page 272 of the Dungeon Master's Guide there are a set of optional rules for lingering injuries.

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:

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

You might instead say one occurs when a creature is reduced to 0 hit points for the second time in a combat/between short rests. Whichever you choose though, make sure to clear it with your players. Tell them that you would like to use this rule, when you want them to occur, why you want this, and make sure to get their consent. Do not surprise your players with unknown rules like this.

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As far as I know, there isn't anything in the rules that gives the penalty you speak of. From PHB p 197 (emphasis mine):

If damage reduces you to 0 hit points and fails to kill you, you fall unconscious. This unconsciousness ends if you regain any hit points.

and

The number of both [death saving throws] is reset to zero when you regain any hit points or become stable.

That being said, you make a valid argument: falling unconscious three times in one battle would leave a mark. You're free to impose some kind of penalty, but it would be more homebrew than RAW. Examples could be death saving throws with disadvantage or levels of exhaustion.

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