Recently I had a new Dungeons & Dragons 4e campaign start, my first in over 6 months that I was DMing and the first time I had DMed a game since actually getting to sit on the player side of the screen.  Needless to say it made a big difference.  One thing I really wanted to do was patch up some of the holes that my last campaign had as well as some that observed in my gaming experiences.

A big one was going unconscious mid-battle should be a bigger deal than “Oh, I have to start making Death Saves”  So I got to searching for a good way to raise the stakes.  That’s when I stumbled upon this article on RoleplayingTips.com.  It describes a system in which a player sustains an injury when they get knocked out in battle, mostly taken from Dragon Age.   This was my starting point for coming up with my system and it doesn’t change too much from this except for a few minor things.

First of all, I’m not a big fan of unnecesary book keeping and taking a straight minus to an ability score creates just that.  Every skill associated with that ability score gets temporarily changed, the attacks and damage have to be altered, and if you want to be really mean it can alter your hit point total and number of healing surges as well.  Ultimately it just sounded like a big hassle and I wanted to really make it easy.  So I built a system around taking a loss that get tacked on to the end of roll instead of the beginning and having to rework a lot because of it.

My second change was I shortened up the list, but doubled up the results.  Essentially the list got halved and each injury gives minuses to two things.  Some are worse injuries to have than others to be sure, and to get some reprieve I inserted a chance that you would not receive an injury at all.  Also, a player can only suffer a maximum of three injuries at a time. I ended up with this chart:

Roll 1d6.
1	Injured Arm	-1 to Attack and Damage Rolls
2	Injured Leg	-1 to Speed and Initiative Rolls
3	Sore Skull	-1 to Perception and Saving Throws
4	Bruised Rib	Gain Vulnerable 2 to all damage
5	Stomach Wound	Healing Surge Value is Reduced by 1/4
6	No Injury Sustained

Granted, that’s just for the Heroic tier.  I haven’t decided if it will scale in the other tiers of play but I have a good while to decide that.  The next task was to figure out how they can cure their injuries.  The easiest answer was that the next time they are in a non-hostile town (I call them Points of Civilization, which I explain to my players as “Somewhere that has a warm bed, a fluffy pillow, and they aren’t trying to kill you.”) however I wanted to get them a quicker solution.  So I came up with two ways to cure the injury: Rest at a point of civilization or make a Hard DC heal check.

The Hard DC heal check was in hopes that only someone trained in healing would be able to fix the injuries, but even those who aren’t can stand a chance.  The downside to the immediate gratification of healing it through a check is that there is a chance to flub it and make it worse.  A failed check will complicate the injury and make it worse, causing the effects to double (or in the case of a ‘Complicated Bruised Rib’ Vulnerable 5 instead of 2) and a complicated injury can ONLY be healed a point of a civilization.  Still not a complete show stopper, but it does give it a bit of gamble.

So that’s my current system that I’m using to handle injuries when they go unconscious.  It’s a quick and easy system that gives players a few options and still encourages them to not shrug off going unconscious.  Thanks for reading!