Major Injuries Update

A homebrew system for parties who want to earn battle scars.




When a creature of level 3 or higher takes damage equal to half of their hit point maximum from a single source, they must make a DC15 Injury Saving Throw. The major injury table and saving throw ability used are determined by the type of damage received.

Variant. If tanks want to start collecting scars sooner, and squishies want to put it off longer, instead of beginning to risk major injuries starting at level 3, instead begin when each character reaches or surpasses a hit point maximum of 20.

A creature who succeeds takes the damage as normal but suffers no other effects. A creature who fails is considered Injured and must use their Injury Saving Throw result to determine the injury they have acquired from this devastating blow.

A creature who is Injured can be treated with the medicine skill to avoid potential complications that may arise from magical healing (as described on the major injury table). In addition to the effects determined by the major injury table, an injured creature has disadvantage on concentration checks until they receive medicinal treatment and finish a long rest.

Optional: Once a creature has failed an Injury Saving Throw, other creatures cannot receive major injuries for 24 hours (this ensures that the dramatic spotlight doesn’t become diluted and the party doesn’t death spiral during particularly harrowing combats).




12 thoughts on “Major Injuries Update

  1. So, I’m planning to use this for a new campaign for 2022 (thank you), but what kind of DCs do you use for the medicine checks? I know DMs can set whatever they like, but I like having some kind basis for determining the DC. Basic stabilization only requires a DC 10, but for traumatic injuries I imagine it should be higher.

    • Amaranth, this page rarely gets any love (comments/replies), so I’ll tag you and make up an answer… 🙂

      Recall that “DC 10” = “common untrained person fails 50% of the time”. DC 12 = “trained commoner fails 50%”. DC 15 = “trained 1st level PC fails 50%, and this is their good skill”. Increase numbers by 1 every 4 8 (proficiency bonus) [and ignore stat bonuses]. So… if you want a 1st level “medic” to have a good chance at succeeding on these Medicine checks, I’d go with DC 12. If you want this to be really hard and take a naturally talented, experienced practitioner, DC 15. (Or a character with Expertise.)

      If you don’t care who can succeed, but want the repair commensurate with the injury, set the DC either at “the same DC of what caused the damage” or at “11+enemy’s prof bonus”. I.e. burns inflicted by my sorcerer’s Fireball are DC 15 to treat, same as dodging the fireball. An open wound (slashing trauma) from a goblin boss’s scimitar critical hit would be DC 13 (11 + his prof bonus of +2 for being CR 4 or less)…

  2. First, I applaud the investigations you did to develop these tables (rather than just making stuff up)! Kudos!

    Second, you mention repeatedly in the tables and the YouTube video that magical healing sets these effects permanently, but non-magical healing (i.e. Medicine checks) … wait, nope, no rules for how that applies? My sorcerer (42 hp) took a 28 pt burn wound from a dragon (actually happened in a recent game). For the sake of argument, I rolled a “2”, +5 on the CON save (14 CON + proficiency), which gives me a 7: third-degree burns to the chest, half-movement, and I’m passing out in 3 rounds. (curiously, no impairment to my attacks, like with result “8-10”)

    The dwarven cleric rushes to my side; be has a bevy of magical cures available, but he happens to also be trained in Medicine, and has the Healer feat. The player pauses, looking for rules about “should I use Cure Wounds L3? roll a Medicine check? use the Healer feat?” What should he do? Your proposal seems incomplete here…

    • I think these tables are a great improvement of the system shock from 2nd edition (which are pretty hardcore but very interesting and add more realism) and I agree with you that how to cure these major injuries is a bit too vague.
      I’m still working on it because I would like to use these tables but this is what I have come up with:

      When a magic user only has a healing spell but no knowledge of medicine they force the body to accelerate the healing process in a way that may be detrimental to it (think the “skill” from the Farseer trilogy). Thus you use the description for magical healing.

      A healer that heals without magic will take longer but have minimal long term effects. Except when a limb had to be removed, but since you’re already out of combat you could make prosthetics or regeneration a new short quest. I really liked that idea from Dael’s youtube video. It also gives small town herbalists and healers a greater significance for the PC’s story.

      When a healer combines magic with their medicinal knowledge they might roll a medicine check to see if they are able to guide their magic to heal a wound without to much permanent damage. I imagine the DC for this would go up with the seriousness of the injury. So a 1 from the injury table would result in a DC 15 and a 14 only a DC 6. I’m not sure about that yet. I do think I’m going to rule that combining medicine with magical healing will use the healers action and bonus-action.

  3. Something I said on the last Major Injury table, was that someone with a high Con save would never get those bad injuries, therefore I really approve of the Mental trauma been base off of Int save and Magical Afflictions been Cha save (as for @Andy Aiken comment, Force is the Material manifestation of raw magic, not any kind of strengh, therefore is fit well with the mana disturbance of one’s own body).

    Futhermore, while watching the video, the Sorcerer rolling a 1 against the Roc, with the two paths of nat 1= fall inconscience vs add Con save mod and possible skip altogether the harder injuries til the character never get in trouble made me think of a third path: the sorcerer rolled a 1, but actually got a 6, therefore thon would roll a flat d6 to know the nature of the injuri.
    That way a character with poor save (say +1) rolling a 1 would have a 50% chance of falling inconscient on the spot, but the character with high save (say +9, ergo rolling a d10) would only have 10% of it actually happening, with 80 % of that d10 still been worse that actually taking the result of the save itself.

  4. I love this. I feel like Force damage would work really well alongside Thunder on the Concussive Blast table, maybe better than the Magical Afflictions table. Or perhaps it would depend on the source of the damage.

    • Am important point to remember about force damage in 5e is that it isn’t force as in kinetic energy, it’s more like pure magic damage, hence Disintegrate.

    • Andy and cohoare, I can see both viewpoints here. I have always pictured [Force] as concussive, but once Dael gave her viewpoint, it was like an epiphany. Especially with Disintegrate as a reference point. Force damage is more like a Star Trek phaser than a Star Wars blaster… it is a concentration of impact-less energy at a certain point. (Unlike some CRPGs that reinforce – sorry for the pun – the impact mental image by having bodies jerk backwards under the impact of Magic missiles.)

      I don’t know if it is “a surge of arcane energy that overloads your body’s natural equilibrium” (i.e. Magical Affliction), but I think keeping concussion/[thunder] separate from [Force] is probably a good thing in the long run.

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