Grievous Wounds — replaces Hitting 0 HP

Why have this rule?

A consistent theme throughout dark fantasy and related stories is the consequences of actions. While the roleplay ramifications of a party's decision can be highlighted through story outcomes, combat ramifications can be a little harder to implement. Grievous Wounds are an effective method of adding grit and realism to combat encounters, bringing the consequences of a difficult fight to the forefront of storytelling.

Grievous Wounds

Whenever a player character is reduced to 0 HP, they roll 2d6 and subtract from the result the number of existing Grievous Wounds they have. They then apply the modified result from the Grievous Wounds Table. If a player rolls the same result as one they already have a wound for, they skip this result and select the next lowest result they do not have as a wound. Results with a * next to them can be taken more than once.
Upon completing a long rest, and if the character or someone helping them succeeds at a DC 10 Wisdom (Medicine) check, a player can remove all effects from Grievous Wounds, but not Permanent Wounds. See below for Permanent Wounds.

2D6	Grievous Wounds
2 or less	Permanent Wound*. You have sustained a serious wound that is most likely permanent. Roll on the Permanent Wound Table and apply the result.
3	Internal Bleeding*. You have suffered an internal hemorrhage and bruising. Your hit point maximum is halved.
4	Concussion. You have received a minor concussion and struggle to focus on complicated tasks. You gain the dazed condition.
5	Laceration. You have taken a deep injury which you are bleeding from. You gain the bleeding condition.
6	Deep Wound*. You have taken a blow that under different circumstances would kill most humanoids. When you are reduced to 0 HP, you start with an additional failed death saving throw.
7	Battered*. Your muscles ache and you have had the wind knocked out of you. You gain a level of exhaustion.
8	Sprained Wrist*. You have badly sprained your wrist and are unable to use it effectively. You are unable to hold objects in one of your hands and you cannot take actions that require that arm.
9	Damaged Eardrum. You have suffered a blow to the head and your hearing has been impaired. You gain the deafened condition.
10	System Shock. You have suffered a severe nervous system shock. You have disadvantage in Dexterity checks to determine initiative.
11	Sprained Ankle*. You have badly sprained your ankle and are unable to use it effectively. Your speed on foot is halved and you cannot take the dash action. If you receive this result a second time your speed on foot becomes 0.
12	Close Call*. You Narrowly miss an otherwise dangerous blow. Instead of being reduced to 0 hit points, you fall to 1 hit point instead and become prone.

Permanent Wounds

Permanent wounds are injuries that were not lethal but left the recipient maimed. They represent a serious impediment that requires creativity to overcome (e.g. getting a prosthetic limb), especially at lower levels. The effects of a permanent wound are irreversible unless the recipient is targeted with the regenerate spell, upon which one permanent wound is removed.

1D6	Permanent Wounds
1	Fatal Wound. Through an unrecoverable injury, you have been fatally wounded. You are now dead.
2	Lost Arm*. You have suffered a serious injury to your arm or have lost it entirely. You are unable to hold objects in one of your arms and you cannot take actions that require two arms.
3	Lost Leg*. You have suffered a serious injury to your leg or have lost it entirely. Your speed on foot is halved and you cannot take the dash action. If you receive this result again your speed on foot becomes 0.
4	Lost Eye*. You have lost the use of a good eye. You have disadvantage on Wisdom (Perception) and Intelligence (Investigation) checks that rely on sight. If you receive this result again, you gain the blinded condition.
5	Scarred Lungs. Undertaking vigorous activities causes you to break out in a coughing fit. If you take an action, you cannot take a bonus action until your next turn. If you take a bonus action you cannot take an action until your next turn.
6	Hideous Scar. You have been horribly and visibly scared. You have disadvantage on Charisma (Performance) and Charisma (Persuasion) checks. Additionally, indifferent NPCs may prefer not to converse with you.