I had a “Why don’t they use a Phoenix Down on Aeris?” moment last week playing through Dragon Age: Awakenings. A dying soldier is encountered that’s “beyond healing magic now.” It reminded me how much of a hash HP plus an easy means of recovering them can make of verisimilitude and genre emulation. This system is designed for 3.x/Pathfinder, but probably works with 4e as well (and may be extra useful with the ease of HP recovery there that has recently been discussed by Harbinger). It’s similar in some ways to the Earthdawn wounds system except A) it allows some compensating benefits so it’s not entirely awful for players, B) it hopefully requires a little less bookkeeping, and C) I can’t call it Wounds because that would make the Cure spells confusing.

This system serves to make games grittier, for the most part, but does also allow low level characters some ability to avoid dying all the time from minor amounts of damage.

Injury Threshold

Each character has an Injury Threshold equal to positive Con Mod plus Base Attack Bonus.


  • A first level barbarian with 18 Con has an Injury Threshold of 5.
  • A first level wizard with 10 or less Con has an Injury Threshold of 0.
  • A Fighter 5, Rogue 2 with Con 14 has an Injury Threshold of 8.

Note: This threshold does increase when under a temporary Con or BaB increase (e.g., Barbarian Rage, Endurance, Transformation, etc.)

Taking Injuries

Whenever a character takes more HP damage (from a single source of damage) than his or her Injury Threshold, add an Injury to that character. Injuries have no specific identity, though some groups may wish to include descriptions for flavor. It’s the total number that’s important.

A critical hit that exceeds the Injury Threshold (as it hopefully will unless dice luck is against you), does its critical modifier in Injuries (so 2, 3, or 4 instead of 1).

Whenever a character would suffer an Injury or be reduced to 0 or fewer HP, the player can choose to take an additional Injury to make a Fortitude save (difficulty equal to the damage dealt). Success reduces the incoming damage by half or leaves the character at 1 HP (whichever results in the higher HP total), but does not retroactively reduce the attack below the Injury threshold (e.g., if your Injury Threshold is 5 and you took 8 damage, a successful save results in 4 damage and 2 Injuries).

This last effect is designed to make this system have some positive benefit for players so it’s not universally awful (and to model the brave dying ally that held out until magical healing was useless), but it can serve to make play drag. It is suggested that it only be used by major enemies and NPCs that have a tremendous need to survive (e.g., defending something they believe in, trying to get a message through, confronting someone hated, etc.).

Effects of Injury

For any use of Cure spells on the character, the caster must succeed at a Caster Level check with a difficulty equal to the total Injuries, or the spell is ineffective. Even if the spell is successfully cast, the effect is reduced by the number of injuries to a minimum of 0 (e.g., a Cure of 8 HP on a character with 5 Injuries only heals 3 HP).

Every morning, the character takes damage equal to total Injuries. (At the GM’s discretion, this may also happen to NPCs that took a large number of Injuries in pursuit of a mission immediately after a final conversation with the PCs). Natural healing is subtracted from this damage (and it will often simply reduce damage healed when total Injuries are less than Character Level).

Total Injuries may increase the DC for certain poisons, diseases, and environmental effects at the GM’s discretion.

If total Injuries ever exceed Con score + Character Level, the character dies.

Removing Injuries

Once per week (on the morning of whatever the religious day of rest is in the setting), a character can make a Fortitude save against a DC equal to total Injuries. Success removes one Injury. For each 10 points by which the roll exceeded the DC, the character removes an additional Injury. This occurs before the day’s Injury damage/natural healing is applied. A character that has been treated by a Healer that week can substitute a Heal check result for his or her Fortitude save (as with helping against Disease or Poison).

Any spell or effect that restores ability damage allows an additional save at the time of the effect. In particular:

  • Lesser Restoration: Injuries must be specifically targeted by the spell (i.e., you don’t heal any other ability damage).
  • Restoration: this save is in addition to all other effects of the spell.
  • Heal or Greater Restoration: this save is in addition to all other effects of the spell and the caster can immediately roll Heal to substitute for the save as described above.