Dramatic Injury

When a creature is brought to zero Hit Points by damage, or takes damage to its Hit Points equal to one third of its Hit Point maximum at one time(after resistances and reductions), it sustains an injury. It is useful to note this threshold on a character's sheet; if the character's Maximum Hit Points changes, so does the threshold. Damage to Temporary Hit points or other buffers like the Abjuration specialist's ward does not count toward an injury.

Unless the nature of the injury dictates the target area, such as a bear trap or psychic attack, roll on the table below. Certain creatures are immune to some, or all injuries based on their physiology.

Where Does It Hurt

d20 Injury 1 Face 2-4 Head 5-9 Torso 10-13 Arms 14-15 Hands 16-19 Legs 20 Feet

Aim for the Eyes!

If a player character injures the target of their attack, you may allow the player to choose the area instead of rolling. This allows shot-calling without cumbersome penalties or qualifications on the attack roll, and weights the ability to aim attacks in favor of characters most likely to do so in fiction.

Injuries Without Damage

Injury can be an improvisational tool for narrative injuries to the player characters or NPCs. Fatally wounded allies with parting words, retired adventurers whose old wounds keep them from taking the field, a hand sliced open in ritual blood offering, badly failing a Strength ability check to kick down a door and hurting a leg. All of these can be represented by some kind of injury.

Attack Riders

Some creatures like the poisonous snake, rakshasa, and werewolf have special effects on their attacks, often after a Constitution saving throw. Rider effects like these venomous or cursed bites and stings take place automatically when they cause an injury instead of imposing a saving throw after each attack.

Since there are more ways to avoid an injury than to succeed on a Constitution saving throw, you may consider making injury poisons a more serious threat.

Safety Squints Engaged

If the location of an injury is protected by protective equipment like medium or heavy armor, the injury may be mitigated or negated at the DM's discretion. See the Equipment chapter of the PHB for description of armor types.

If a character chooses to wear a full helm with their hide armor, it doesn't affect their AC calculation, but when they're hit in the head by a falling rock trap, they'll be glad to have it on. Adding a pair of heavy gloves to a breastplate may protect the hands from fire or a cockatrice's bite. A bard might be especially glad to receive a pair of magic gloves that keep their hands safe, and an old wizard's floppy, weather-stained hat might hide a protective dweomer.

Do you use item durability? When a shield or piece of armor helps a creature avoid serious injury, it may have taken damage. Better it than you!

Treatment and Recovery

Injuries are more difficult to remove than abstract HP damage. The effects may be decreased or suppressed temporarily by the use of a healer's kit, curative magic of any level, or other creative applications of the Medicine skill, such as improvised bandages or a crude splint. Injuries are cured and removed by time(whether it be until a short or long rest is finished, or longer), medical attention, and potent magical means.

While it heals, an injury is vulnerable to mistreatment and abuse. For example, if a character has a hairline fracture in their arm, taking another injury to the same arm or rolling a 1 on an attack with that arm may overstress the injury, making it more serious. The reverse is also true: a severe injury may become a lesser one before it goes away entirely.

Occasionally, an injury that isn't cared for may not heal correctly, such as a bone that isn't set before it heals. Such an injury becomes permanent, short of dangerous voluntary surgeries or a wish.

Medicine. Injured creatures don't usually have an innate knowledge of the exact effects, only the symptoms they feel. A Wisdom or Intelligence(Medicine) check can be made to diagnose injuries and come up with a treatment. A proficient character with the proper tools can make a Dexterity(Medicine) check to perform surgery.

Herbalism and Alchemy. Simple potions of healing are treated as a stimulant and analgesic by this system, able to keep you going but not repair your serious wounds. More potent concoctions like Keoghtom's ointment are effective at removing injury. An herbalist can also create palliatives and remedies that speed up recovery.

Magical Aid. A lowly cure wounds prayer may close and scab over scratches, cuts, and abrasions, but a deep enough trauma to be represented by an injury is too serious. As a general rule, higher level healing spells such as heal or regenerate can end an injury immediately.

Scars

Most injuries will leave a scar marking the misfortune. Severe injuries leave severe and disfiguring scars, which may be difficult to conceal. Spells like heal or regenerate, can remove such scarring. A high level cleric may not have the scars of their younger days, but a paladin probably will. A collection of scars is a badge of station with others who take the wages of violence, but might hamper your ability to move in upper social circles. Unless an injury heals in such a way as to avoid scarring, note the scar on your character sheet.