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I had a player fighting against sahuagin by the shore the other day and he was dropped to 0 and dying. Because of his location, though, he landed in shallow water (2-3' deep) which I ruled was enough to drown in.

The rules for suffocation (PHB pg. 183) are specific to state:

A creature can hold its breath for a number of minutes equal to 1 + its Constitution modifier (minimum of 30 seconds). When a creature runs out of breath, it can survive for a number of rounds equal to its Constitution modifier (minimum 1 round). At the start of its next turn, it drops to 0 hit points and is dying.

I was having difficulty adjudicating this because the character was already at 0 and now was just inhaling water.

In this scenario, does the character just make death saves as normal, or would they automatically fail them?

FYI, I ruled that he would auto-fail the saves since he's just inhaling salt water now and takes a level of exhaustion, but if the rules have something specific for this, it'd be helpful to know.

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In my PHB the full suffocation rule is (emphasis mine):

A creature can hold its breath for a number of minutes equal to 1 + its Constitution modifier (minimum of 30 seconds).

When a creature runs out of breath or is choking, it can survive for a number of rounds equal to its Constitution modifier (minimum 1 round).

At the start of its next turn, it drops to 0 hit points and is dying, and it can't regain hit points or be stabilized until it can breathe again.

For example, a creature with a Constitution of 14 can hold its breath for 3 minutes. If it starts suffocating, it has 2 rounds to reach air before it drops to 0 hit points

This is my RAI interpretation of your situation:

  • The character is unconscious and dying from damage, and begins making death saving throws immediately
  • The character cannot voluntarily hold their breath, so the minutes are not applicable here - the rounds before the dying effect of suffocation begin immediately
  • If the suffocation effect's rounds elapse, then the character cannot regain HP or be stabilized until they can breathe, and are dying from suffocation (and possibly damage as well, but there is no RAW precedent for stacking these)

That large, bolded part of the rule is the most important aspect of this situation. If a druid casts healing word on a character before suffocation's dying effect kicks in, they're back in the fight. If not, healing word fails to revive them - someone must help them breathe first.

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Death Saves as normal.

First of all, it's not getting water in one's lungs that's inherently deadly: it's that we can't extract oxygen from that water, and so we die of lack of oxygen.1 In 5e this is already modeled by

rounds equal to its Constitution modifier (minimum of 1 round).

This mechanic will work any time your character is deprived of oxygen, for any reason. Underwater, sealed in a vacuum chamber, ejected to the elemental plane of no-air, &c.

Secondly, and tangentially, the character might not even be getting water in their lungs: there's a diving reflex that mammals have where the larynx spasms shut and prevents liquid from entering the lungs. This is the reason for so-called "dry drowning."2

In any case, this is one case where the rules-as-written actually do a shockingly good job of modeling real-world deadly circumstances. Let them do their work, and get back to playing the game =)


1 - I mean, it's not good to take your lungs for a soak, and may still kill you... it's just not that wetness is likely to kill you in 30 seconds, like suffocation or death saves will.

2 - the first bits of liquid that hit your lungs typically set off a laryngospasm, stopping any more from entering. Once the mouth/larynx is clear of liquid the so-called "gasp response" sets in, restarting the breathing process.

Of course open-water lifeguard training was decades ago, so take this all with a heaping of "the dim fog of memory".

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Dropping into water with 0 hp is the equivalent of falling in while winded. You didn't have a chance to hold your breath and immediately begin the death/dying sequence. It's not an instant death, just dying.

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    \$\begingroup\$ Just a note: Answers need to be supported. This would be improved with some support, as the other answers have done. We've been having a lot of meta discussion on supporting answers lately, so I thought I'd share that. \$\endgroup\$ – KorvinStarmast May 31 at 16:15
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If you fall unconscious in water, you still have your CON mod amount of minutes before you even begin to suffocate. Your diving reflex will see to that.

Someone mentioned that you wouldn't "have time to hold your breath". You don't need any time.
You just stop breathing = holding your breath.
An instant decision. Try exhaling and then keep you mouth closed. You can easily sit like that for half a minute.

The RAW rules hit the nail on the head. Regular death saves while unconscious under water. If he stabilises, then at some point within a few minutes, he starts drowning, and thus dying, without the ability to stabilise before being pulled out of the water.

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It is death saves as normal (since he is already at 0 HP and would already be required to make death saves).

However, this gets a little murky in that he is in a situation where he gets a round or more (based on CON mod) before he starts drowning.

Initially, he is only making death saves against the initial damage that dropped him to 0, so I would rule that he makes deaths saves as normal, but that each round he does so also counts toward those CON rounds before suffocating.

Unless he has a really high CON score, it probably wouldn't matter in the long run.

Situation 1 - High CON (+3 or up CON mod)

A high CON character MIGHT be able to stabilize the initial damage before drowning by hitting 3 successes before their CON bonus in rounds pass, but in that situation once the CON rounds for suffocation pass they would start the death saves over again (as if they were starting the saves fresh, since they stabilized the first set of saves - so another 3 failures needed before death). This would continue until they hit 3 failures (since there is no stabilization while suffocating) regardless of how many successes they have.

Situation 2 - Average or low CON (up to +2 CON mod), or high CON character failing to stabilize before CON mod rounds pass.

A character with an average CON score would burn through the round or two they would get for drowning before stabilizing, which would only mean they'd continue their death saves until they had three failures regardless (again, since there is no stabilization while suffocating) without any chance at stabilizing even the initial damage.

A string of 6 or more successes would only postpone the death waiting at the end of three failures. That string of successes would possibly give an ally time to get to them and pull them out of the water though.

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