Lingering Injuries

“I used to be an adventurer like you, then I took an arrow in the knee.” - Town Guard, The Elder Scrolls V: Skyrim

Damage normally leaves no lingering effects. This option introduces the potential for long term injuries. More frequent injuries allows combat to have roleplaying consequences and creates a grittier, more realistic flavor, but can cripple characters' fighting ability.

Inflicting Injuries

It's up to you to decide when to check for a lingering injury. Keep in mind that player characters are subject to these effects far more frequently than monsters, so be careful when deciding how often you want to use this option.

A creature might sustain a lingering injury under the following circumstances:

  • Rarely: When it fails a death saving throw by 5 or more
  • Occasionally: When it drops to 0 hit points but isn't killed outright
  • Frequently: When it takes a critical hit or rolls a natural 1 on a saving throw

Types of Injuries. To determine the nature of the injury, roll a d20 after damage and all other effects have been resolved. If the injury was from Bludgeoning, Slashing, or Piercing damage, reference those tables. If the injury was from a different damage type, reference the Magical Injuries table. A result of 1-10 is a Major Injury and 11-20 is a Minor Injury for that damage type.

Roleplaying Lingering Injuries. Instead of using the effect described on the tables, you can put the responsibility of representing a character's lingering injury in the hands of the player. Roll on the Lingering Injuries tables as usual, but instead of suffering the effect described for that result, that character gains a new flaw with the same name. It's up to the player to express the lingering injury during play, just like any other flaw, with the potential to gain inspiration when the injury affects the character in a meaningful way.

Major and Minor Injuries

Some lingering injuries are more debilitating than others. When determining the severity of an injury, you can apply Advantage or Disadvantage depending on the circumstances.

Roll with disadvantage when conditions are more likely to cause a major injury:

  • The damage is of a type the target has vulnerability to.
  • The injury is inflicted from a creature more than one size category larger than the target.
  • The injury is inflicted from a creature with a CR or level higher than the target's.
  • The amount of damage causing the injury is greater than or equal to half its hit point maximum.

Roll with advantage when conditions are more likely to cause a minor injury:

  • The damage is of a type the target has resistance to.
  • The injury is inflicted from a creature more than one size category smaller than the target.
  • The injury is inflicted from a creature with a CR or level less than half the target's.
  • The target has legendary actions.

Recovery

Unlike wounds, most lingering injuries can't be healed with normal rest. If no duration is noted in the injury, the effect persists until the afflicted creature recovers.

Minor injuries can be recovered from with magical healing such as cure wounds, or spending five days doing nothing but resting.

Major injuries can usually only be removed with magical healing of 6th level or higher, such as heal and regenerate. At your discretion, the effects can be reduced through long-term adaptation, prosthetics, or magical assistance such as mage hand.

If an effect calls for a saving throw, someone can use their action to perform First Aid and make a Wisdom (Medicine) check in place of your next saving throw.

Infection

If a creature sustains a major injury, magical healing or a healer's kit must be used to dress the wound within 24 hours. If not, it becomes a festering wound. In addition to the effects of the major injury, the creature suffers the effects of a Minor Necrotic Injury as described on the Magical Injuries table.

The infection heals if the creature receives magical healing, or from any effect that cures disease. Alternately, someone can tend to the wound and make a DC 15 Wisdom (Medicine) check once every 24 hours. After three successes, the infection heals.

Non-humanoids

This table assumes a typical humanoid physiology, but you can adapt the results for creatures with different body types. For example, an injury that affects the legs might affect the wings of a flying creature. If an injury would target a body part without an obvious analogue, roll again. If the reroll also fails, the creature does not sustain a lingering injury.

A creature can't suffer a lingering injury from a damage type it is immune to. Creature types without discernible anatomies are immune to certain types of lingering injuries; other immunities may apply at the DM's discretion (such as suffocation for creatures that don't need to breathe.)

Type Typical Immunity
Construct All
Elemental Bludgeoning, Slashing, Piercing, Poison
Ooze All
Plant Piercing
Undead Piercing, Poison

Inspired by /u/GrasseatingGiant's 5e conversion of AD&D Critical Effects and the Injuries option in the Dungeon Master's Guide pg 272.

This document v. 0.4 by Peter "Galemp" Oliver 12/02/2019.

Bludgeoning Injuries
d20 Type Injury
1 Head, Major Fractured Skull. You drop to 0 hit points. If you stabilize or regain hit points, you remain unconscious.
2-5 Arm, Major Shattered Arm. You cannot use weapons or objects that require the use of two hands, and have disadvantage on Strength ability checks and saving throws.
6-7 Torso, Major Crushed Chest. You begin suffocating and drop to 0 hit points. If you are already at 0 hit points, you can’t regain hit points or be stabilized until you can breathe again.
8 Abdomen, Major Internal Bleeding. At the start of each of your turns, you must make a DC 15 Constitution saving throw. On a failed save, your hit point maximum is reduced by 1. If your hit point maximum reaches 0, you die. The effect ends if someone tending to you succeeds on a DC 15 Wisdom (Medicine) check during a short or long rest.
9-10 Leg, Major Shattered Leg. If you move more than 5 feet on your turn, you fall prone at the end of the movement. You have disadvantage on Dexterity ability checks and saving throws.
11 Head, Minor Concussion. You are stunned until the end of your next turn. You have disadvantage on Wisdom and Intelligence ability checks.
12-15 Arm, Minor Broken Hand. You can no longer hold anything with two hands, and you can hold only a single object at a time.
16-17 Torso, Minor Broken Ribs. Whenever you attempt an action under great stress, such as in combat, you must make a DC 10 Constitution saving throw. On a failed save, you lose your action and can't use reactions until the start of your next turn.
18 Abdomen, Minor Winded. You are stunned until the end of your next turn.
19-20 Leg, Minor Broken Foot. Your speed on foot is reduced by 5 feet. You must make a DC 10 Dexterity saving throw after using the Dash action. If you fail the save, you fall prone.
Suffocating

When a creature runs out of breath or is choking, it can survive for a number of rounds equal to its Constitution modifier (minimum of 1 round). At the start of its next turn, it drops to 0 Hit Points and is dying, and it can’t regain Hit Points or be stabilized until it can breathe again.

Slashing Injuries
d20 Type Injury
1 Head, Major Disfigurement. You are horribly scarred to the extent that the wound can't be easily concealed, such as losing a nose or ear. You are blinded for one minute. You have disadvantage on Wisdom (Perception) and Charisma (Persuasion) checks, and advantage on Charisma (Intimidation) checks.
2-5 Arm, Major Lose an Arm or Hand. You can no longer hold anything with two hands, and you can hold only a single object at a time.
6 Torso, Major Laceration Trauma. You have disadvantage on attack rolls, and attacks made against you have advantage. Whenever you attempt an action under great stress, such as in combat, you must make a DC 15 Constitution saving throw. On a failed save, you lose your action and can't use reactions until the start of your next turn.
7-8 Abdomen, Major Disemboweled. You drop to 0 hit points. If you are already at 0 hit points, you fail one death saving throw.
9-10 Leg, Major Lose a Foot or Leg. Your speed on foot is halved, and you must use a cane or crutch to move unless you have a peg leg or other prosthesis. You fall prone after using the Dash action. You have disadvantage on Dexterity checks made to balance.
11 Head, Minor Facial Injury. You have disadvantage on Wisdom (Perception) checks and Charisma (Persuasion) checks.
12-15 Arm, Minor Lose a Finger. You drop anything that you are holding. You have disadvantage on Dexterity (Sleight of Hand) checks and checks to use tools.
16 Torso, Minor Chest Scar. The scar doesn't have any adverse effect.
17-18 Abdomen, Minor Open Wound. At the start of each of your turns, you must make a DC 10 Constitution saving throw. On a failed save, you take 1d4 slashing damage. On a successful save, the effect ends.
19-20 Leg, Minor Limp. Your speed on foot is reduced by 5 feet. You must make a DC 10 Dexterity saving throw after using the Dash action. If you fail the save, you fall prone.
Blindness

A blinded creature can’t see and automatically fails any ability check that requires sight.

Attack rolls against the creature have advantage, and the creature’s attack rolls have disadvantage.

Deafness

A deafened creature can’t hear and automatically fails any ability check that requires hearing.

Piercing Injuries
d20 Type Injury
1 Head, Major Lose an Eye. You have disadvantage on ranged attack rolls and Wisdom (Perception) checks that rely on sight. If you have no eyes left after sustaining this injury, you are blinded.
2-3 Arm, Major Shoulder Injury. You have disadvantage on attack rolls, and Strength ability checks and saving throws.
4-5 Torso, Major Heart Pierced. You drop to 0 hit points. If you are already at 0 hit points, you fail one death saving throw.
6-8 Abdomen, Major Gut Ruptured. You are poisoned. At the start of each of your turns, you must make a DC 15 Constitution saving throw. On a failed save, your hit point maximum is reduced by 1. If your hit point maximum reaches 0, you die. The effect ends if someone tending to you succeeds on a DC 15 Wisdom (Medicine) check during a short or long rest.
9-10 Leg, Major Hip Injury. If you move more than 5 feet, make a DC 15 Constitution saving throw. On a failed save, you fall prone and are are paralyzed until the end of your next turn. You have disadvantage on Dexterity ability checks and saving throws.
11 Head, Minor Broken Jaw. You can't speak or cast spells with verbal components.
12-13 Arm, Minor Torn Muscle. You drop anything that you are holding. You have disadvantage on Strength ability checks and saving throws.
14-15 Torso, Minor Punctured Lung. At the start of each of your turns, you must make a DC 10 Constitution saving throw. On a failed save, you begin suffocating. If you suffocate for a consecutive number of rounds greater than your Constitution modifier (minimum 1 round) you drop to 0 hit points.
16-18 Abdomen, Minor Internal Injury. Whenever you attempt an action under great stress, such as in combat, you must make a DC 10 Constitution saving throw. On a failed save, you lose your action and can't use reactions until the start of your next turn.
19-20 Leg, Minor Broken Kneecap. Your speed on foot is reduced by 5 feet. You must make a DC 10 Dexterity saving throw after using the Dash action. If you fail the save, you fall prone.
Magical Injuries
Type Injury
Acid, Major Equipment Melted. All nonmagical equipment worn or carried made of wood, leather, cloth, or other organic material, is destroyed.
Acid, Minor Corrosion. At the start of your turn, make a DC 10 Constitution saving throw. On a failed save, you take 1d4 acid damage. On a success, the effect ends.
Cold, Major Deep Freeze. You are petrified, and appear to be encased in ice.
Cold, Minor Frostbite. At the start of your turn, make a DC 10 Constitution saving throw. On a failed save, you take 1d6 cold damage. On a success, the effect ends.
Fire, Major Severe Burns. You have vulnerability to all damage.
Fire, Minor Skin Burns. You have vulnerability to fire damage.
Force, Major Major Disintegration. Roll on the Slashing Injuries table with disadvantage. That body part is mostly disintegrated instead of severed.
Force, Minor Minor Disintegration. Roll on the Slashing Injuries table with advantage. That body part is partially disintegrated instead of severed.
Lightning, Major Paralysis. You are paralyzed.
Lightning, Minor Shock. You can't take reactions until the end of your next turn.
Necrotic, Major Soul Rot. You are cursed and your hit point maximum is reduced by 1 every hour. If your hit point maximum reaches 0, you die and become a zombie under the DM's control.
Necrotic, Minor Festering Wound. Your hit point maximum is reduced by 1 every 24 hours. If your hit point maximum reaches 0, you die.
Poison, Major Death Stroke. You drop to 0 hit points. If you are already at 0 hit points, you fail one death saving throw.
Poison, Minor Poisoning. You are poisoned. At the start of your turn, make a DC 10 Constitution saving throw. On a success, the effect ends.
Psychic, Major Insanity. You suffer from Long Term Madness as described on DMG 260.
Psychic, Minor Confusion. You behave as if affected by the confusion spell. The saving throw DC is 10.
Radiant, Major Self-Immolation. At the start of your turn, make a DC 15 Charisma saving throw. On a failed save, you take 1d12 radiant damage. If you fail the save while at 0 hit points, you die and your body (but not gear) is reduced to ash.
Radiant, Minor Blindness. You are blinded. At the start of your turn, make a DC 10 Constitution saving throw. On a success, the effect ends.
Thunder, Major Blast. You fall prone and are pushed 30 feet from the origin of the damage. Roll on the Bludgeoning Injury table.
Thunder, Minor Deafness. You fall prone, and are deafened.