Grievous Wounds

Grievous Wounds

In the standard 5e system, the act of being reduced to 0 hit points carries little weight. A character who suffers a devastating injury can be brought back to their feet with a single point of healing, as if the mortal blow they just endured was little more than a scratch. While this approach simplifies gameplay, it introduces several issues that detract from the narrative, the mechanics, and the overall engagement of the game.
From a narrative perspective, the current rules fail to capture the drama and tension of combat. A character who has just been cut down by a mighty axe or seared by a dragon’s flame should not simply spring back to life moments later, ready to fight as though nothing happened. These moments, which should be fraught with peril and leave lasting marks on the story, often pass without consequence. This disconnect between the game’s mechanics and its narrative can pull players out of the experience, robbing these pivotal moments of their emotional weight.
For players, the lack of meaningful consequences for reaching 0 hit points fosters a playstyle that prioritises efficiency over immersion. Healing is often withheld until a character is downed, as it is more effective to revive them than to prevent them from falling in the first place. This strategy not only diminishes the stakes of combat but also reduces the role of healers and support characters to mere tools for minimising risk, rather than integral parts of the party’s survival.
Mechanically, the absence of significant consequences for hitting 0 hit points misses an opportunity to add tension, strategy, and drama to the game. Without a real sense of danger tied to reaching 0, the urgency and tactical depth of combat encounters are diminished. The narrative risks and sacrifices that define truly gripping moments of storytelling are often absent, as the system doesn’t support them.
The Grievous Wounds system is designed to address these shortcomings, not by increasing the difficulty of the game but by enhancing its narrative and mechanical depth. This system ensures that falling to 0 hit points is a moment of high drama, creating a sense of peril that lingers even after the immediate danger has passed. Each injury tells a story, whether it is a lingering wound that hinders the character or a permanent scar that becomes a part of their identity. These wounds add stakes to combat, making every decision more impactful and every battle more engaging. By tying healing to the recovery of injuries, Grievous Wounds also shifts the focus of healing in combat. Rather than being a last resort to get a character back on their feet, healing becomes a proactive strategy to prevent injuries and mitigate their effects. This approach encourages more thoughtful and tactical play, as players must weigh the risks and rewards of their actions with the long-term consequences in mind.
Ultimately, the Grievous Wounds system seeks to align the mechanics of the game with its narrative, making every hit, every injury, and every moment on the battlefield feel meaningful. It adds layers of tension, strategy, and storytelling, transforming the act of falling to 0 hit points from a minor inconvenience into a pivotal moment that shapes the character’s journey. This isn’t about punishing players or making the game harder; it’s about making the game richer, deeper, and more engaging. After all, the most memorable stories are the ones where the scars tell their own tales.

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Suffering a Grievous Wound

When a character is reduced to 0 hit points by damage, they must roll a D20 on the Grievous Wound Table corresponding to the type of damage that reduced them. The Dungeon Master determines which table is appropriate based on the source of the damage (e.g., Slashing, Fire, Psychic) which reduced the character to 0 hit points. The D20 roll must be made without any modifiers to the roll. The result will yeild one of three results:

• Natural 20: The character avoids a grievous wound but sustains a condition which causes the character to gain 1 level of exhaustion, which can be removed by normal means.
• Natural 1: The character suffers a Permanent Injury, determined by the table for the damage type.
• Other Results: The character suffers a Lingering Injury, determined by the table for the damage type.

If a character would suffer a Grievous Wound with an effect they already have, instead of duplicating the injury, the result escalates to the next higher result on the table. This escalation reflects the compounding severity of repeated injuries and ensures the consequences remain impactful.

Lingering Injuries

A Lingering Injury imposes a detrimental effect on the character until it is healed. Each Lingering Injury has a target injury hit point pool that represents the amount of healing required to fully recover from the wound. This pool is separate from the character’s normal hit points and must be tracked independently. Healing applied to a Lingering Injury does not restore the character’s regular hit points and vice versa.
When a character receives healing, they must choose whether to apply it to their normal hit points or their Lingering Injury pool. These pools are distinct, and healing one does not affect the other. Healing that is applied to the Lingering Injury pool contributes toward meeting the injury’s target value, which is specified in the injury’s description. Once the total healing applied to the Lingering Injury pool equals or exceeds the target value, the injury is considered fully healed, and its detrimental effects are removed.

• Example: A character with a Lingering Injury requiring 50 points of healing to recover has a separate injury pool starting at 0. If they receive magical healing for 10 points and apply it to the injury pool, the pool increases to 10, leaving 40 points remaining before the injury is healed.

Healing Lingering Injuries
A Lingering Injury can heave hit points applied to its hit point pool in the following ways.

• When a character regains hit points through magical means, expending Hit Dice, or using a healer’s kit, they may apply that healing to either their current hit points or their Lingering Injury pool.
• At the end of a short rest, a character adds 10 hit points to their Lingering Injury pool.
• At the end of a long rest, they add 25 hit points to the pool.

Permanent Injuries

A Permanent Injury represents a lasting consequence, such as the loss of a limb, a scarred eye, or a damaged lung. These injuries cannot be healed through ordinary means but may be removed through specific magical effects, such as the Regenerate spell, or through significant narrative events determined by the DM. Permanent Injuries serve as a reminder of the toll combat takes, adding depth and narrative weight to the character’s story.

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Grevious Wound Tables

Acid

D20 Result	Grevious Wound	HP Target	Effect
20	Skin Hypersensitivity	N/A	You sustain 1 level of exhaustion
16-19	Superficial Disfigurement	30	You have disadvantage on Persuasion checks.
11-15	Partial Blindness	40	Your sight is reduced to 30 feet.
6-10	Exposed Bones	50	You have vulnerbility to bludgeoning and slashing damage and your hit point maximum is reduced by twice your character level.
2-5	Neuralgia	50	Whenever you attempt to take an action, you must first succeed a DC 8 Constitution saving throw, or loose the action.
1	Destroyed Eye	N/A	You have disadvantage on all perception checks which rely on sight.

Bludgeoning

D20 Result	Grevious Wound	HP Target	Effect
20	Winded	N/A	You sustain 1 level of exhaustion
18-19	Broken Nose	30	You loose your sense of smell and taste. You automatically fail any perception checks that rely on smell.
16-17	Concussion	30	You have disadvantage on Intelligence checks.
13-15	Broken Leg	40	Your walking speed and jump distance is halved
11-12	Broken Arm	40	You loose the use of one arm.
6-10	Internal Bruising	50	You have vulnerability to bludgeoning and force damage and your hit point maximum is reduced by twice your character level.
2-5	Broken Ribs	50	Whenever you attempt to take an action, you must first succeed a DC 8 Constitution saving throw, or loose the action.
1	Amnesia	N/A	You fall unconcious for 1d4 hours when this injury is sustained. When you wake you do not remember anything that has happened in the last 1d4 hours for which you were concious, and you have disadvantage on all History checks.

Cold

D20 Result	Grevious Wound	HP Target	Effect
20	Hypothermia	N/A	You sustain 1 level of exhaustion
16-19	Frostbitten Toes	30	Your walking speed is reduced by 5 feet.
11-15	Cellular Damage	40	You have disadvantage on Strength and Dexterity checks.
6-10	Frost Bitten Hands	50	You have disadvantage on all attack rolls and ability checks which rely on your hands.
2-5	Neurelgia	50	Whenever you attempt to take an action, you must first succeed a DC 8 Constitution saving throw, or loose the action.
1	Lose 1d4+1 Fingers	N/A	You have disadvantage on all slight of hand checks.

Fire

D20 Result	Grevious Wound	HP Target	Effect
20	Heat Stroke	N/A	You sustain 1 level of exhaustion
16-19	First Degree Burn	30	You have vulnerbility to fire damage
11-15	Second Degree Burn	40	You have vulnerbility to fire damage and have disadvantage on Constitution saving throws.
6-10	Third Degree Burn	50	You have vulnerbility to fire damage and any other damage which makes physical contact with you.
2-5	Neurelgia	50	Whenever you attempt to take an action, you must first succeed a DC 8 Constitution saving throw, or loose the action.
1	Horrible Disfigurement	N/A	You have disadvantage on all persuasion checks.

Force

D20 Result	Grevious Wound	HP Target	Effect
20	Sapped	N/A	You sustain 1 level of exhaustion.
16-19	Soul Tear	30	Whenever you are reduced to 0 HP, you immediatly fail 1 death saving throw.
11-15	Weave Sickness	40	You have disadvantage on saving throws against spells.
6-10	Blindness to the Mundane	50	You are constantly under the effect of Detect Magic. However, you are blinded and cannot see anything nonmagical.
2-5	Degloved Limb	50	You loose the use of one of your arms or your total speed is halved. In addition, you reduce your maximum hit points by an amount equal to three times your character level.
1	Flesh Avulsion	N/A	You loose a significant chunk of flesh from your torso. You reduce your maximum hit point total by an amount equal to half your character level (rounded down).

Lightning

D20 Result	Grevious Wound	HP Target	Effect
20	Cardiac Injury	N/A	You sustain 1 level of exhaustion
16-19	Muscle Spasms	30	You have disadvantage on Dexterity checks and saving throws.
11-15	Arc Flash Burn	40	You have vulnerbility to lightning damage and disadvantage on Constitution saving throws.
6-10	Minor Brain Damage	50	You reduce your intelligence score by 3.
2-5	Cardiac Arrhythmia	50	On your turn, if you attempt to both, willingly move and take an action, you must succeed on a DC 20 Constitution saving throw or fall unconcious until the start of your next turn.
1	Severe Nerve Damage	N/A	You loose all feeling in your fingers. You make all slight of hand checks with disadvantage.

Necrotic

D20 Result	Grevious Wound	HP Target	Effect
20	Withered	N/A	You sustain 1 level of exhaustion.
16-19	Weary	30	You have disadvantage of Strength checks.
11-15	Flesh Necrosis	40	Your AC decreases by 1.
6-10	Acute Haemophilia	50	After taking slashing, piercing, bludegeoning, or necrotic damage, you loose 2 hp every six seconds until you receive magical healing or a creature uses their action to make a successful DC 10 medicine check on you.
2-5	Flesh Sloughing	50	When you take physical damage, you must succeed on a DC 10 Constitution saving throw or take an additional 4 points of necrotic damage.
1	Cancerous Cells	N/A	Your remaining lifespan decreases by a number of years equal to 1/4 of your race's average lifespan. You reduce your maximum hit point total by an amount equal to half your character level (rounded down).

Piercing

D20 Result	Grevious Wound	HP Target	Effect
20	Cardiac System Damage	N/A	You sustain 1 level of exhaustion.
16-19	Punctured Leg Muscle	30	Your walking speed is reduced by 5 feet.
11-15	Torn Arm Muscle	40	You loose the use of one arm.
6-10	Internal Bleed	50	After taking slashing, piercing, bludegeoning, or necrotic damage, you loose 2 hp every six seconds until you receive magical healing or a creature uses their action to make a successful DC 10 medicine check on you.
2-5	Ruptured Organ	50	Reduce your hit point maximum by an amout equal to three times your character level.
1	Destroyed Eye	N/A	You have disadvantage on all perception checks which rely on sight.

Poison

D20 Result	Grevious Wound	HP Target	Effect
20	Nausea	N/A	You sustain 1 level of exhaustion.
16-19	Immune Hypersensitvity	30	You have vulnerability to poison damage.
11-15	Cyclic Vomiting	40	Whenever you consume anything, you must succeed on a DC 20 Constitution saving throw or violently vomit up most the food causing you to loose a hit die if one is avaliable. If a hit die is notavalible, you take 1d10 poison damage.
6-10	Liver Damage	50	You have vulnerability to poison damage. In additon, you have disavantage on Constituition and Strength saving throws.
2-5	Sepsis	50	Each time you finish a long rest (Short rest if using JOL Grittier Resting Rules) you must succeed on a DC 10 Constitution saving throw of be Poisoned for the next 24 hours.
1	Kidney Failure	N/A	You have disadvtage on saving throws against being poisoned.

Psychic

D20 Results	Grevious Wound	HP Target	Effect
20	Mentally Drained	N/A	You sustain 1 level of exhaustion.
16-19	Crippling Doubt	30	You have disadvantage on Wisdom saving throws.
11-15	Migraines	40	You have disadvantage on ability checks and in bright light. You also have disadvantage on Constitution saving throws.
6-10	Minor Brain Damage	50	You reduce your intelligence score by 3.
2-5	Intracerebral Haemorrhage	50	Whenever you attempt to take an action, you must first succeed a DC 8 Constitution saving throw, or loose the action.
1	Psychosis	N/A	You have disadvantage against saving throws against being frightened.

Radiant

D20 Results	Grevious Wound	HP Target	Effect
20	Sapped	N/A	You sustain 1 level of exhaustion.
16-19	Soul Tear	30	Whenever you are reduced to 0 HP, you immediatly fail 1 death saving throw.
11-15	Partial Blindness	40	Your sight is reduced to 30 feet.
6-10	Radiant Burn	50	You have vulnerbility to fire damage and any other damage which makes physical contact with you.
2-5	Deconsecrated	50	Whenever you regain hit points (excluding those applied to your Lingering Injury pool), you regain only half the amount of hit points rolled, rounded down.
1	Premature Ageing	N/A	You age by a number of years equal to 1/4 of your race's average lifespan. You reduce your maximum hit point total by an amount equal to half your character level (rounded down).

Slashing

D20 Result	Grevious Wound	HP Target	Effect
20	Blood Loss	N/A	You sustain 1 level of exhaustion.
16-19	Slashed Calf	30	Your walking speed is reduced by 5 feet.
11-15	Ruptured Tendon	40	You loose the use of one arm, or your walking speed and jump distance is halved.
6-10	Deep Laceration	50	After taking slashing, piercing, or bludegeoning damage you loose 2 hp every six seconds until you receive magical healing or a creature uses their action to make a successful DC 10 medicine check on you.
2-5	Ruptured Organ	50	Reduce your hit point maximum by an amout equal to three times your character level.
1	Lose a hand	N/A	You lose a hand, and have disadvantage on all slight of hand checks. You may still use your stump for somatic componenets, or strap a weapon or shield to the forearm which lost the hand.

Thunder

D20 Result	Grevious Wound	HP Target	Effect
20	Winded	N/A	You sustain 1 level of exhaustion.
16-19	Tinnitus	30	You have disadvantage on perception checks which rely on sound.
11-15	Deafness	40	You loose your sense of hearing. You automatically fail any perception checks which rely on sound.
6-10	Internal Bruising	50	You have vulnerability to bludgeoning and force damage and your hit point maximum is reduced by twice your character level.
2-5	Collapsed Lung	50	On your turn, if you attempt to both, willingly move and take an action, you must succeed on a DC 20 Constitution saving throw or fall unconcious until the start of your next turn.
1	Chronic Vertigo	N/A	You have disadvantage on acrobatic checks and any other check made to maintain balance.

Jacobs Musing
There is a peculiar weight to the study of injuries and ailments. Each broken bone, each fever that burns through a body like wildfire, each organ that silently fails—these are stories of life’s fragility, of its impermanence. When I was younger, studying anatomy in the city of Kalazart, I approached the subject with curiosity and ambition. I sketched meticulous diagrams, unravelled the mysteries of tendons and veins, and marvelled at the resilience of the humanoid form. But now, when I think of it, there is little marvel left—only sorrow.

I cannot help but reflect on how much can go wrong within our fragile forms. A single infection can bring down the mightiest warrior. A single clot can steal the most brilliant mind. And yet, there was a time when I believed that knowledge could conquer all. That with enough study, enough experimentation, we could mend every wound, cure every ailment, defeat even death itself.

I was wrong.

There was someone I loved, once, who needed more than my meagre knowledge could provide. My wife. She was vibrant, full of life, and then one day, she wasn’t. I poured everything I had into trying to save her. I combed through every scroll, every book, every scrap of wisdom I could find. I sought advice from healers, from clerics, even from charlatans who promised miracles. I even experimented—on animals, on plants—trying to replicate the patterns of life and stave off the inevitable.

I failed.

She left this world too soon, and I was left with the bitter taste of failure. I told myself there was nothing more I could have done, that I had exhausted every option. And yet, the thought gnaws at me still: what if the answer was there all along, buried in some book I didn’t read, some scroll I didn’t study closely enough?

Since then, I’ve avoided medical texts. They sit on my shelves, gathering dust, taunting me with their silence. I cannot bring myself to open them. Not because they lack fascination—they are, after all, repositories of immense knowledge—but because I am terrified of what I might find. What if, in some forgotten corner of a page, I discover the cure I so desperately sought, too late to save her? What would that do to me?

I think about her often. About the pain she endured, about the helplessness I felt watching her slip away. And I think about others who must feel the same—the parents who lose children, the spouses who lose partners, the friends who lose the ones who made them laugh.

It’s not just the injuries of the body that wound us, but the scars they leave behind on our hearts.

There is a cruel irony in our world. Magic flows through the very fabric of Estara, and yet there are limits to what it can achieve. Clerics heal the wounded, alchemists concoct salves and potions, but even their powers cannot stave off every illness, cannot save every life. It’s a humbling truth: for all our advancements, for all our ingenuity, we are still so fragile.

And yet, I must admit, there is a beauty in our fragility. It is our impermanence that makes life precious. The fleeting nature of our existence forces us to cherish the moments we have, to hold tight to those we love.

Even so, the bitterness lingers. It is difficult not to wonder if our fragility is a flaw in creation, or a test, or simply the way of things. And it is even harder to resist the impulse to fight it, to seek answers, to strive for mastery over that which seems so uncontrollable. I often wonder if I will ever find peace with this. Or if I will always feel the pull of those dusty tomes, calling me to search once more for the answers I couldn’t find when they mattered most. But for now, I let them lie. I am not ready to face them. Not yet.