I'm interested in adding a touch of realism to combat in D&D 3.5 or Pathfinder. Hit points are a very simple way of measuring injury and stamina, that contributes to the "hit things first, ask questions later" attitude of a lot of players. They believe any injury they sustain can be healed with a night's rest and some attention from their cleric, so combat doesn't feel as potentially deadly as it should.

On the other hand, I don't want to introduce a huge, unwieldy injury system. I want something that takes no more than a couple of seconds, or the roll of one die, and that is as close as possible to the system the players are used to.

What injury systems have people seen, used or invented?


21 Answers 21


Keep in mind any injury system with long term hindrances applied will always affect the PCs more than NPCs/monsters over time and you'll need to adjust for that. Bad guys tend to get either killed in the initial encounter or at least only fought once, so later limping or whatnot never comes up, but it would stay around to degrade the PCs' party. Not to say that's bad, but the average adventure tends to capstone with a high CR encounter with the assumption that wounds don't make the PCs hit less hard.

You could instead use a more short term effect, where someone who gets "really pounded" for any of the above definitions of really pounded (half hp, single big blow, loads of hp in a round) takes penalties for being staggered or whatnot just for the current fight. The assumption is that after, you regain your breath and wrap up your wound or whatnot and it's not permanently degrading your abilities.

What we use in our game is the Paizo GameMastery crit cards, where on crits you pull a card and something besides or in addition to the damage happens to you; some are short and some are long term. It's not directly tied to amount of damage or hit points but that's actually arguably appropriate - it's more about the luck of the hit severing a tendon or hitting a bad spot than the raw amount of damage (also means that D&D doesn't favor the two-handed big hit weapons even more than it already does).

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The Pathfinder game I'm scheduled to join in a few weeks has one of these. I've reproduced it below. (©2010 Vivian Abraham)

Hit Points, Conditions, and Healing

Conditions, or what happens when you are knocked below zero hit points

Hit points represent your character's ability to avoid lethal damage. When you reach zero hit points or go negative, you gain a negative condition at the discretion of the GM.

For example:

Grignr the Barbarian faces off against Sargon the Sorcerer in the public arena, a dispute over the ownership of some gem. Grignr fells Sargon with one mighty blow of his axe, slamming him to the ground. Sargon's leg is broken, reducing his move rate and giving him -2 on all rolls, including his Concentration check to cast, due to the excruciating pain. Sargon musters his strength, makes his concentration check, and casts a maximized sound burst on the hapless Grignr, knocking him below zero. He makes his Fortitude save against the stun effect of the spell, but now has a concussion, lowering his rolls by 4, including his initiative while he desperately attempts to clear his head. Grignr aims another mighty blow at Sargon, critting again, and neatly splits him in half.


Hit points heal fast. With an hour's full rest, you'll get them all back. Conditions require more work. Simple conditions like a light fracture or a minor burn can be alleviated over time with an appropriate Heal check or immediately with a cure light wounds. More serious conditions require more time, better Heal checks, or stronger healing spells.

Healing spells still cure the same number of hit points.

For example...

The spell cure serious wounds has two effects. First, it can be used to cure a number of hp. Second, it can be used to remove certain negative conditions, such as a broken bone. If someone has no hp and has a broken bone, cure serious wounds will both heal the broken leg and heal hp. If a cure moderate wounds is used, it will only heal the hp damage, not the broken leg. Proper application of the Heal skill, together with rest, can downgrade negative conditions over time. So if you broke your leg a few days ago, had it set and splinted, and haven't been walking on it, it could be downgraded to a moderate wound.

Sample Conditions

  • Black eye / swollen eye / blinded
  • Ringing in your ears / deafened
  • Stunned / Concussed / Unconscious
  • Light fracture / Broken Bones / Compound fracture
  • Minor blood loss / serious blood loss / critical blood loss
  • Minor burn / serious burn / critical burn
  • Wheezing / choking
  • Exhausted / slowed / paralyzed
  • Dead

So, to sum up...

  1. There are no negative hit points.
  2. Once you run out of hp (or an attack takes all of your hp, plus some), you gain a negative condition of the GM's choice.
  3. Conditions are cumulative, and will lead to character death unless they are tended to.
  4. There is no complete list of conditions, as characters have such unique methods of getting in trouble.
  5. NPCs will most often receive the condition "dead".
  6. The Heal skill treats conditions and helps you determine their severity, and therefore what spell is best suited to tend to it.
  7. Hit points heal fast. Conditions take treatment and time, or the appropriate level spell.

Side note - feats and abilities that affect negative hit points will need adjustment. For example. Die Hard now allows you to ignore a single negative condition.

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    \$\begingroup\$ I like this bit: "Hit points heal fast. Conditions take treatment and time." I also like that there's no single table of all possible effects, since it gives me the freedom to come up with plot-specific ones. On the other hand, a guide to what penalties are fair would stem accusations of DM bias. \$\endgroup\$ – Marcus Downing Sep 3 '10 at 22:49
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    \$\begingroup\$ I really like this system. I'm going to try to toss it into my party's next encounter as a taste of it. @Marcus I agree with your last statement, but I would also say if you're worried about DM bias, this isn't the only thing that will cause problems in your campaign. In my opinion, if you don't have some trust/faith in your DM, you shouldn't play with him, or you're really not going to enjoy your game. \$\endgroup\$ – corsiKa Jun 26 '11 at 22:11
  • \$\begingroup\$ This is very interesting to me, but I am hesitant to use it without more of a resolution system. For example, how do you determine which "category" of conditions is applied, or which condition in that category to choose? How do you determine which category a particular condition belongs in? Naturally I'm sure it's a judgement call, but it seems like a table or a set of formal descriptions is in the spirit of 3.5/PF. Given that this was answered years ago, I suspect you've played with this system; what worked for those games? \$\endgroup\$ – TheRubberDuck May 28 '14 at 14:17

I want to add just 2 cents to the already good answers. You have plenty of very valuable positive feedback in the other questions, and I feel compelled to present a stand out feedback.

The D&D system with hit points is by-design created without injury in mind. There are two facts to consider.

The first fact is that the hit points system is not made to represent how many wounds a character takes. It is made to reduce the chance of being wounded mortally. I will explain myself with an example. Say you are a very young, real (not in-game) warrior. Your lack of skills to parry and reduce damage is reflected in the fact that facing an enemy, you are hit easily and this wound can disable your ability to fight and defend yourself considerably or even totally. [*] On the other hand, if you are a very skilled swordsman, your ability to parry is increased, and you considerably reduce the danger of getting wounded.

D&D mapped this real-world scenario into two characteristics: the first is AC. the second is hit points. A very skilled, high level character has a bunch of hit points not because he is able to absorb one hundred hits with a sword. It is that because of those one hundred successful hits, the highly skilled warrior is actually able to parry (even if they pass the armour class). The master renders this fact as "you are hit", but it's not an accurate description of the game mechanics. It can clearly produce absurd situations such as a highly level warrior falling hundreds of meters and stepping away like Wile Coyote, but ok...

So, when a highly skilled warrior is "hit" in D&D, he is not actually hit. He is just more able to prevent damage from potentially dangerous attacks than a low-level character. If you include a wounding rule every time a character is hit, you are biasing against high level characters, because the actual in-game hits resulting from a throw are not real-world hits at all.

The second point is that the d20 system is not really well suited for partial disabling. Yes, you can fit it, and you can also have fun with it, but it is a system made for heroes, like those in the chanson de Roland, the Iliad, Odissey, Aeneid, and so on. These people are meant to be supernatural in some way, because the game system wants them supernatural. Introducing a system that on purpose makes this superheroes with a strong defect such as a broken arm and therefore unable to use a weapon makes the game unbalanced.

This fact is also well exposed in the pure essence of the d20. Kill everything. Real world does not work like this. A real-world fight is a dangerous activity which must be avoided at any cost, unless strictly necessary. Game systems such as GURPS are less focused on fights, and are more similar to a real world scenario.

[*] Roman warriors used a short, fast sword (gladio) because the point was to hit the enemy just slightly, and that was enough. A broad sword with a strong impact would surely mess up the enemy, but even a superficial wound is enough to put a warrior onto his knees. Romans understood this and preferred agility and ability to hit your opponent fast and then get to safety instead of brutal dismembering of the opponent with a clumsy sword, staying without a defensive guard and unbalanced for an insanely huge time.

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How about the following I've just invented, it's very simple and uses existing mechanics. In a way it's similar to how a disease works.

  1. When you reach a trigger, such as 1/2 hit points or lot's of damage in one hit, then you've got an injury. DM can describe a suitable injury for the situation.
  2. Decide how the injury effects the character, perhaps a penalty to hit, or a reduced maximum hit point total. If you are feeling mean then a penalty to all roles.
  3. Every day just like a disease the character needs to make a fortitude save, against a DC to determine whether or not he has healed from the injury. You could for example require 2 successful saves to recover.

Here's an example:

Rogar just took a massive blow from an orc reducing him from 42 hit points to 10, 
as this was more than half his hit points he's now got an injury.

The DM decides the orcs warhammer has broken a bone, Rogar's player has a penalty
applied to all his roles, say -2. Or we could say he's can't have more than 21 hit
points, half his max.

The next morning Rogar's character rolls a fortitude save to see if he can shake off
the negative effects. He rolls 16 against a DC of 15, success!

You could demand more than one success depending on the injury.

The injury hasn't magically disappeared and may take longer to heal, but the successful save means that the character has managed to deal with the injury to the point where it's not effecting his rolls.

Risking an injury and having a -ve to rolls, or a reduced maximum hit point total, for a couple of days should make your players rethink their "hit things first, ask questions later" attitude.

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  • \$\begingroup\$ This is about right. There can be a variety of different triggers, some resulting in more serious injuries than others - for example, suffering a critical hit, reaching zero, critically fumbling etc. \$\endgroup\$ – Marcus Downing Sep 3 '10 at 22:20

From D20 Modern:

Massive Damage: If you take damage equal to or exceeding your constitution you must make a fortitude save against the damage. If you fail, go directly to -1.

I think this would be a very quick change into an injury system. Simply instead of going unconcious on a failure, take an injury.

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Rather than using a different game's subsystem, why not repurpose a subsystem from 4e?

The Disease Subsystem from 4e is perfect for this. Why?

It models a lingering malady, and connects to both the heal skill and penalities in a way that is DC, monster level and genre appropiate.

Lets take my example from the make a disease thread

Flail Chest----------------Level 9 disease

Your enemies blow crushes your rib cage, leaving you with a rattling dripping wound that won't heal quickly.

Attack +12 vs Fortitude, Improve Dc 21, Maintain Dc 16, Worsten less than 16, first check is 1 min after afflicted, further checks every hour.

The Target is cured <---> Initial Effect, the target loses a healing surge and is slowed

Secondary Effect (gangreen), When the target is bloodied, the target gains Vulnerable all 5

Final Effect (sucks to be you), Whenever the target is hit while bloodied they are knocked prone

Flail Chest is what happens when ribs break in multible places and sections of your rib cage have no support. Its not a conventional disease but it models fine. You could perhaps make a dozen diseases, (it would take an hour) Broken Legs, Broken Arms, Concussion, Shock, etc, etc. that would cover most of your major debilitating damage families and throw them on monsters when you want.

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  • \$\begingroup\$ Interesting. I don't know a lot about 4e or its disease system, so this wouldn't have occurred to me. I'd probably want to simplify it a bit. \$\endgroup\$ – Marcus Downing Sep 3 '10 at 14:57

One thing that I think is important to note is that in 4th ed, until you are bloodied, the idea is that the enemy hasn't hurt the player in any meaningful way. Sure they have winded them and worn down their defenses but they aren't really much more than tired or "roughed up" until they drop below half. This is way all of the regeneration powers only work on bloodied players. Until that point their is nothing to regenerate.

Keeping that in mind, I'd suggest that whatever mechanic you come up with doesn't kick in until they are bloodied.

The system we use borrows heavily from Warhammer Fantasy RPG and its critical wound cards. Any time a player is reduced to 0hp they have to draw a wound card. Wound cards are basically negative conditions that persist until the next extended rest + healing. We have added complexity by allowing heal checks to speed along the process and endurance checks to ignore the effect but thats not need.

The whole reason we started using this system was because we were getting tired of situation coming up were it was more "efficient" to let a player drop below zero before healing them then it was to try to keep them standing. Since the wound cards range from minor (a facial wound resulting in social penalties) to severe (slowed due to a broken leg), the players tend to take self preservation more seriously.

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    \$\begingroup\$ That's how I prefer to see hit points too. They're less about health and injury than they are about stamina and exhaustion. \$\endgroup\$ – Marcus Downing Sep 3 '10 at 22:58
  • \$\begingroup\$ Yep, the hard part is keeping the flavor consistent. It's easy enough to say the ogre's heavy attacks are tiring a character out. It's harder to make that work with an acid attack or even a crossbow bolt. Plus, it's hard as a DM to narrate the first half of the battle as mostly bloodless. \$\endgroup\$ – SladeWeston Sep 8 '10 at 23:26

From my experience, I've never come across a rule system for injury (beyond basic HP) that worked well in game without bogging play down. There are times when a disfigurement works well in game, however. But I think it should be a situation that fits the storyline, rather than some rule and dice roll. For example, one of my characters was turned to stone. While a statue, his arm was broken off. When he was turned back to flesh, he continued to have only one arm. And he had to deal with that from then on.

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I came up with a Table of Death & Dismemberment for my B/X D&D game. The assumption is that hit points represent your fitness to keep fighting, rather than biological structural integrity. Once all your hit points are gone, further "hits" actually start impacting the body and cause actual damage.

Gah! Having issues trying to copy and past it here. Anyway, it makes B/X D&D less deadly, but might have the opposite effect with Pathfinder, so use with caution.

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    \$\begingroup\$ @Marcus Downing We've used this approach in my B/X game too and it does give the kind of feel I think you're looking for. Warhammer Fantasy Roleplay used to use this as well. \$\endgroup\$ – cr0m Mar 25 '11 at 5:11

It's a relatively interesting thing you are looking for. You admit that the HP system is very basic and contributes to the problem, but don't want to substantially change it. The answer you agree upon is very ambiguous, needing an undifferentiated trigger amount and a somehwat ambiguous effect.

The thing that jumpS out is that you are trying to give players a little more of the feeling that combat is dangerous. Also, you don't get into the effects that healing has, or even some very simple ways to create this attitude change without some of the bookkeeping.

Full disclosure here...I reduced HP and increased armor protection almost 30 years ago; to create a more deadly feel and one that made armor more important for survival. The reasons behind this were similar; that PC's of any level don't worry about a creature hitting them with a weapon. They can be peppered with arrows, slashed by 5 sword blows, whatever, their ability to avoid damage must be worn down.

That's one reason criticals were created. To remind the big, bad pcs that some gnoll fresh off the turnip cart might get in a lucky shot. The frst way to create dangerous combat is to create critical hits that might just hit an artery, or slice a tendon. So in an article about healing and combat attitude, mentioning the amount of damage caused is not out of place. Healing needs scare PCs. Not as much as the possibity of you telling the 6th level CPs that the orc archer rolled a critical hit for 42 hits of damage. That possibility will change their tactics a lot more, since a minimizing being hit at all is what you seem to be looking for in the players.

Secondly, most potions and spells heal HP. But when you start telling PCs that some amount of their HP can't be healed by normal magic because it was structural damamge, they will act differently. So instead of imposing random or difficult to explain penalties, You use the larger damage amounts to equate to structural damage. In this situation, I'd figure out the full curve of probable damage for most weapons, and say that any time they suffer a single blow of more than 80% of it, that was a structurally damaging blow, and those HP need rest or more powerful magic to heal. Say that you decide that that amount is 15 hits at once. This causes little ill effect until the adrenaline wears off, but now that warrior with 70 HP who took 45 hits in 4 shots, 2 that were over 15 hits. Because of these 2 massive blows, he is told that he can only be healed to 40 HP without rest or very powerful magic. Nothing major to adjudicate, except this character is going to try to rest up.

A slightly different route, especially since you chose an answer, but I thought this might open up some possibilities.

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    \$\begingroup\$ I guess my attitude might seem half-hearted, in not wanting to make the major modifications that D&D needs to become more realistic. My focus here is above all what's fun for the players; realism is only one means to that end. And the fact is, my gaming group are lazy hack-and-slashers, so trying to force them to play something too sophisticated is likely to fail. Fun is also the reason I favour specific nerfs over simply killing the PCs. \$\endgroup\$ – Marcus Downing Sep 6 '10 at 13:56
  • \$\begingroup\$ My own version? celtricia.pbworks.com/w/page/14956418/Taking%20Damage \$\endgroup\$ – LordVreeg Jan 16 '12 at 16:26

Fantasy Craft has a Table of Ouch, which includes such things as:

36-40: Battered limb (1d6: 1–3: –2 with actions taken using the arm, 4–6: Speed reduced by 10 ft.)

Any injury (other then the lowest result — Bleeding) takes 1d4 months to heal.

Characters (both PCs and NPCs) can be forced to roll on it if an attack threatens a critical, the damage exceeds the targets Con and the attacker spends 2 action dice.

They also have to roll if they take more than 25 points of damage in a single hit and fail a Fort save.

This keeps the threat of a nasty, lingering injury present, but isn't so common that characters are forever accumulating penalties on the PCs.

Of course, Fantasy Craft wouldn't be the game it is if it didn't come with options to make it deadlier, so turn on Deadly Combat to make threats more common, Hewn Limbs to force the Fort save after 16 points of damage (and to make it 2d20 when rolling on the Table of Ouch), and so on.

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  • \$\begingroup\$ +1 for proposing that injuries are healed in months, not weeks. Everyone, who has had a broken broken condition should know that. \$\endgroup\$ – Vorac Sep 21 '12 at 11:58

Check out the Injury variant rule in the d20 SRD. The executive summary:

  • Divide damage by 5, rounding up.
  • Make Fort save vs DC 15 + the above number + current hits (see below).
  • Success: unhurt.
  • Fail < 10: 1 hit.
  • Fail by >= 10: disabled.

Each hit adds a cumulative penalty to future Fort saves vs Injury.

There's a bit more to it (healing, non-lethal damage), but basically you've got a system where you get worn down by each successive hit until you're limping around, struggling to act, and too much exertion knocks you down to dying.

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    \$\begingroup\$ This looks like it is designed as a partial conversion of the M&M damage save system LeguRi mentioned. \$\endgroup\$ – Jeff Feb 17 '11 at 12:47

If you want to keep it simple, whereby you don't have to make extra rolls or add complete systems, then you have (ab)use the HP system itself. If Hit Points represent the way characters deal with combat and injury then their maximum Hit Points represent their full ability of dealing with combat and injury when fully rested and healed; and current hit points represent their ability to deal with them at the moment.

I reckon you can make one small change to represent permanent injury without going into full details and allowing you to continue telling the story you want:

Damage exceeding a character's Constitution score + Character Level lowers that character's Maximum Hit Points by the amount exceeded.

This forces players to think about every single encounter in a new way: how to avoid permanent damage. Are there diplomatic solutions? Can we sneak around? This leads to a new level of excitement in the players. They can heal and rest all they want but one arrow to the knee and things will be complicated later on. You can be a hero now but how often can you be a hero?

Furthermore, there are some variations you can add to this.

One large drawback is the fact that if characters don't level up quick enough, they will not gain Max HP quickly enough to remain relevant in combat. This is especially imperative at lower levels. There are several solutions you can use for dealing with this:

  1. Regain a set amount of Max HP each time the characters takes a full rest.
  2. Regain a set amount of Max HP every day/week/month.
  3. Regain a set amount of Max HP every time the character levels up.

The set amount can be something as simple as a number or maybe related to Constitution or its modifier. This ensures that a stat as important as Max HP does not creep towards 0 pushing the character out of combat altogether and adding one extra line to the rule above should not be too difficult to remember and carry out.

Another variation is to include actual injuries as some people like to do. This actually makes it a lot more complicated than you might want it to be. This variation has the player roll on an injury table like those you can easily find around the net or make yourself. This table has a number of injuries which affect a character in some way statistically. The question arises on how to ascertain a character receiving one such injury.

  1. You could allow the player to make the choice. If the character were to receive so much damage that they were to take a hit to their Max HP, they can forego this damage in exchange for rolling once on the Injury Table.
  2. When the damage exceeds twice that of the character's threshold, they instead have to roll on the injury table instead of receiving the Max HP damage.

(In both cases, if the Injury Table has increased steps of severity, you could add the exceeding damage as a bonus on the roll, making the injury automatically more severe if the damage was higher.) This ensures a certain level of control over the damage to Max HP, being able to negate large chunks of it when a character receives a severe beating.

If you find that you want diseases or poison to particularly debilitating, you can have them do Max HP damage instead of normal damage or other forms of impairment.

Last, but not least, you can add a variation to armor instead of further tweaking my suggestion. Using something like the Damage Reduction armor from Unearthed Arcana would be extra useful since it will negate a lot of the damage to Max HP. As such, armor will represent the way it prevents injury.

I hope this is helpful and I would love to hear if you used any of my suggestions and how they worked out. Good luck with your campaign!

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  • \$\begingroup\$ So I was rethinking this. In a fantasy setting you may want to use the Fortitude Save as the threshold or at least something that scales with the character's levels such as Con Score + Character Level. Otherwise, your character will lose significant amounts of Max HP when up against a wizard's fireballs and the like. \$\endgroup\$ – Wineballs Jun 29 '14 at 0:34

This probably counts as a "huge, unwieldy injury system" but another alternative is to ditch hit points and adapt the Mutants and Masterminds Damage Save system.

The idea is that - in addition to Fortitude, Reflex and Will saves - each character has a Damage save based off their Con modifier. When you are attacked you roll a save versus the damage; check the save result in the list below:

  • If the save exceeds the damage: No damage; the character's hide/armor is tough enough to endure the attack.
  • If the damage exceeds the save by 5 or less: The character suffers a -1 to future Damage saves.
  • The damage exceeds the save by 6 to 10: The character suffers a -1 to future Damagesaves, and is stunned. Alternately, the character is injured and sustains a -1 to a body part.
  • The damage exceeds the save by 11 to 15: The character suffers a -1 to future Damage saves, and falls unconscious.
  • The damage exceeds the save by 16 to 20: The character is dying.

In this kind of system, armor doesn't increase AC (which then deserves a different name like "Defense") but instead Damage saves.

I like this system because it makes damage and combat into a less quantitative concept and more qualitative - better for the narrative.

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In the past I've imposed attack/damage penalties for players that get damaged often. I.E. you've been beat almost to death, you take -2 attack and -3 damage for the next 5 days of game time (or shorter if they manage to get to a nice inn and really rest up).

I've never instituted anything permanent like a limp (which would reduce speed permanently) or a faulty arm/leg (attack/damage reduction permanently).

You could probably do an attribute reduction ... reduce strength if your arm/leg gets hacked up or reduce intelligence, wisdom, charisma if you take alot of blows to the head/face.

I'd only give out these injuries for repeatedly being knocked out or taking massive amounts of damage over and over.

I don't think there are any rules laid out in the D&D manuals so I'd say make up your own system.

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I had a rule where if you suffered more than your Constitution score (or half your Con score) in damage from one attack you got an injury - a broken leg (movement penalty) or you lost an eye (vision penalties).

There was no set system for what injury or what penalties it incurred - I kind of winged all that :P

But if I recall some GM manuals have rules describing certain injuries. The first edition of the Star Wars d20 System Core Rulebook (from the year 2000) had a sidebar on the page about injury and death, which explained the rolls were affected by injury to specific body parts:

| Body part | Rolls affected                                                     |
| Head      | All attack rolls, save and checks                                  |
| Eye       | Appraise, Craft, Demolitions, Disable Device, Forgery, Pilot,      |
|           | Repair, Search, Sense Motive, Spot and Survival checks, initiative |
|           | rolls, Dexterity checks, Reflex saving throws.                     |
| Ear       | Diplomacy, Listen and Sense Motive checks, Initiative rolls        |
| Hand      | Climb, Computer Use, Craft, Demolitions, Disable Device, Escape    |
|           | Artist, Forgery, Pilot, Repair, Sleight of Hand, and Treat Injury  |
|           | checks, attack rolls.                                              |
| Arm       | Climb and Swim checks, attack rolls, Strength checks               |
| Foot/Leg  | Climb, Jump, Move Silently, Ride, Swim and Tumble checks, Dexterity|
|           | checks, Reflex saving throws; reduce speed by 2 meters             |
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GURPS characters have a hit point pool based on Strength. How special damage is resolve is based on the hit location and amount of damage relative to your original total. For example if you go below 1/3 hit point your move and defense are cut down. If you hit the arm and do more than 1/2 hit points in damage the arm is crippled.

Runequest 2 (Chaosium) in contrast has a global hit point but divided it among different hit locations. So that the arm has say 5 points and so on.

For D&D games I would first do a list of results that occur when you do damage in multiple of somebody's constitution. For example if you take a single blow of 1/3 CON you are stunned for a round, 1/2 CON knocks you down.

I play with a rule that going below zero knocks you unconscious. You die at -3 hit points but.. you get to raise (lower?) this by -3 per level until you reach a maximum of your constitution. So somebody who is 6th level or higher and has an 18 constitution will only die if they read -18.

I also play with a rule the if you roll a 20 or better (doesn't have to be natural) you can do a head shot if the target is not wearing a helmet. The target has make a save to stay conscious.

If this doesn't do the trick then you can try adding hit location and rating special results by a factor of constitution similar to GURPS.

Beyond this I am afraid that you straying from D&D territory and should look at more tactically detailed game. In which I case I recommend GURPS, Basic Roleplaying, Mongoose Runequest II or Harnmaster. All RPGs that have well designed detailed combat system.

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I've used my own houserule in AD&D 1, 2, and D&D 3.0..

Any hit on a medium creature doing Con or more results in save vs death (fort save in 3.0) or gain some malady. I used a hit location table. Amount failed by is weeks to heal and penalty to use part until healed. When healed, roll a save vs death (fort) to avoid retaining half the penalty permanently.

1d8... 1d6+2 if from below, 1d6 if from above, 1d4 x2 from left side, 1d4x2-1 from right.
1: head
(subtable) 2: torso
3: R Arm
4: L Arm
5: Abdomen
6: hands or feet (subtable)
7: R Leg
8: L Leg

Hand/Foot subtable (1d6)
1 R hand
2 L Hand
3 R hand if equal or from above, R foot from below
4 L hand if equal or from above, L foot from below
5 R foot
6 L Foor

Head subtable (d12) 1 L Eye 2 R eye 3 both eyes 4 L ear 5 R ear 6 Nose 7 mouth 8 jaw 9-12 whole head

Players didn't like it. They thought they would, until they realized it resulted in mangled, incapacitated dudes.

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  • \$\begingroup\$ Would it not be better to have plot-relevant choice of injury, rather than random? \$\endgroup\$ – Marcus Downing Sep 3 '10 at 22:55
  • \$\begingroup\$ D&D never had hit locations at all; my mode imposes a penalty on any use of the injured location. (much the same as in the CORPS system by BTRC.) So I don't need to know what the injury itself is, just where it is and how bad. A permanent -5 to the hand, for example, is probably a missing thumb or several fingers, or a palsy, and applies to weapon attacks, picking pockets, etc... \$\endgroup\$ – aramis Sep 4 '10 at 0:04

If you are interested in how trauma works in real life, then look at the Journal of Trauma. Go to your local doctor and ask them about it. Better yet, if you live in a major city, head to Emergencies at the hospital and ask them about it. Finally, the US army and marine corps will have reports available from the press office on injuries types in war zones -- including stabbings and accidental trauma.

If you are running D&D/fantasy, medieval medicine centric discussions can be found in history books (especially military history) and at historical departments of universities.

Claim that you are an author (not false) looking for realism in their work if admitting that you are a role player feels awkward.

Note: Yes, I do realise that this is not a RPG system but I have yet to see any RPG system that comes even close to real life. You want realism, learn about it.

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Rolemaster Classic had conversion rules for AD&D or at least how to use the hit tables, criticals and so on with it. You would only need Arms Law to do this.

This could be exceptionally brutal however, it's quite possible to die from a random crit (head exploding, removed, limbs sliced off, etc) in combat - Rolemaster can be very dangerous. It also adds in more time (each attack requires referencing on a table).

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First let me explain how I interpret hit points. They are an abstraction of injury, vitality, spirit, concentration, luck, etc.

If Farmer Joe swings a sword at Ser Knight and scores what would normally be a "good" hit (let's say 5+ hp), that was a true swing, however Ser Knight's excessive training caused him to shift his weight or parry JUST enough with his sword that what would be a mortal strike was deflected into an arm (or perhaps a loud "clang" on his armor). Most players don't want to hear that when they strike and "do X points of damage!" your reply of "ok, you clanged on his armor". So, the first step is to get agreement/buy-in from the players to change what a hit means in your game.

Now, for the meat and crunch of how to solve this problem:

  • If a character takes a hit that is half of their TOTAL hitpoints, that is a mortal wound. (Since I run Pathfinder, I would also apply conditions like bleeding, blind, paralized, etc.)
  • If a character takes a hit that is a quarter of their CURRENT hitpoints, that results in a significant wound. (I would also apply minor conditions after a significant wound for a round or two... the character is off-balance and needs an action to regain their footing)
  • If the character takes a hit that is a tenth of their CURRENT hitpoints, that results in a minor wound. (I would not apply any conditions at this stage).
  • If the character takes a hit that is less than a tenth of their CURRENT hitpoints, the hit is not a true "hit", it is a strike that bounces off of armor or "'tis but a fleshwound!" The reason you still lose hitpoints from the weapon hitting armor and making a loud "clang" is because combat is fast, loud, and chaotic. That loud clang in your ear is distracting.

Yes, this would mean that if a good strike connects at the beginning of combat, it can be easier brushed aside than if it lands at the end of combat. It also means that you could have strikes bouncing off the guy's armor for most of the combat, then suddenly one of those same magnitude hits becomes a significant wound.

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