5th Edition House Rules: Modified Injury and Recovery - Take 2

By on ::        

Earlier, I wrote about some 5th Edition house rules that modified the injury and recovery sub-systems. This is a different approach, that I believe streamlines the design.

As a quick overview:

  • You no longer fall unconscious at 0 HP* (unless someone knocks you out). Instead you gain the wounded condition and immediately make a death saving throw.
  • You no longer die after three failed death saving throws.
  • Each failed death saving throw gives you one level of exhaustion.
  • Optional: I’ve added another level of exhaustion.

With that, here’s the table of contents with a change. And for my game table, I’ll be working on a centralized document that contains the finalized house rules; And maybe even add versioning for it. I still plan to use the magical healing and hit die modifications.

Table of Contents


Dropping to 0 Hit Points

When you drop to 0 hit points, unless the attacker chose to knock you out (see Knocking a Creature Out section), you either die outright (see Instant Death) or become wounded (as per the Being Wounded section.

Instant Death

Massive damage can kill you instantly. When damage reduces you to 0 hit points and there is damage remaining, you die if the remaining damage equals or exceeds your hit point maximum.

For example, a cleric with a maximum of 12 hit points currently has 6 hit points. If she takes 18 damage from an attack, she is reduced to 0 hit points, but 12 damage remains. Because the remaining damage equals her hit point maximum, the cleric dies.

Being Wounded

If damage reduces you to 0 hit points and fails to kill you (or knock you out), you gain the wounded condition and must immediately make a death saving throw. The wounded condition ends if you regain any hit points or become stabilized.

Death Saving Throws

Unlike other saving throws, a death saving throw isn’t tied to any ability score. You are in the hands of fate now, aided only by spells and features that improve your chances of succeeding on a saving throw.

Roll a d20 and consult Table 185: 5th Edition House Rule - Death Saving Throws .

Table 185: 5th Edition House Rule - Death Saving Throws
d20 Result
1 You fail. Gain two (2) levels of exhaustion.
2–9 You fail. Gain one (1) level of exhaustion.
10–19 You succeed. Mark one death save success. You stabilize once you succeed on three successful death saves.
20 You succeed. Remove the wounded condition and role one of your Hit Dice. You regain hit points equal to the result of your roll. (Note: Rolling a Hit Die in this way does not require that you spend that Hit Die)

Once you stabilize or regain any number of hit points, remove the wounded condition and clear all death saves.

Damage at 0 Hit Points. First, if you don’t already have it, you gain the wounded condition. Now apply the damage, which may result in Instant Death or require making one or more Death Saving Throws.

Stabilizing a Creature

The best way to save a creature that is wounded or at 0 hit points is to heal it. If healing is unavailable, the creature can at least be stabilized so that it isn’t killed by a failed death saving throw.

You can use your action to administer first aid to a wounded creature and attempt to stabilize it, which requires a successful DC* 10 Wisdom (Medicine) check. Once stabilized a creature loses the wounded condition.

A stable creature doesn’t make death saving throws, even though it has 0 hit points, but it does remain unconscious. If the creature takes any damage, refer to the Death Saving Throws sub-section. A stable creature that isn’t healed regains 1 hit point after 1d4 hours.

Monsters and Death

Most GMs* have a monster die the instant it drops to 0 hit points, rather than gaining the wounded condition and making death saves.

Mighty villains and special non-player characters are common exceptions; the GM* might have them follow the same rules as player characters.

Knocking a Creature Out

Sometimes an attacker wants to incapacitate a foe, rather than deal a killing blow. When an attacker reduces a creature to 0 hit points with a melee attack, the attacker can knock the creature out. The attacker can make this choice the instant the damage is dealt. The creature falls unconscious and is stable.



  • A wounded creature can’t take reactions.
  • A wounded creature that takes damage must make a death saving throw.
  • A wounded creature that takes damage from a critical hit must make an additional death saving throw.
  • A wounded creature that ends its turn wounded must make a death saving throw.

A creature loses the wounded condition if they gain any number of hit points. Any ability that can remove disease may also remove the wounded condition.


Table 186: 5th Edition House Rules: Seven (7) Levels of Exhaustion (Option 1)
Level Effect
1 Disadvantage on ability checks
2 Speed halved
3 Disadvantage on attack rolls and saves
4 Advantage on attack rolls against you
5 Hit point maximum halved
6 Speed reduced to 0
7 Death
Table 187: 5th Edition House Rules: Seven (7) Levels of Exhaustion (Option 2)
Level Effect
1 Disadvantage on initiative checks
2 Disadvantage on ability checks
3 Speed halved
4 Disadvantage on attack rolls and saves
5 Hit point maximum halved
6 Speed reduced to 0
7 Death


Short Rest

A short rest is a period of downtime during which a character does nothing more strenuous than eating, drinking, reading, and tending to wounds.

If you fulfill one of the above requirements, you may spend one (1) Hit Die to recover hit points. Using a healing kit during the short rest allows you to spend an additional one (1) Hit Die.

For each Hit Die spent in this way, the player rolls the die and adds the character’s Constitution modifier to it. The character regains hit points equal to the total.

Long Rest

A long rest is a period of extended downtime during which a character sleeps or performs light activity: reading, talking, eating, or standing watch for no more than 2 hours. If the rest is interrupted by a period of strenuous activity—at least 1 hour of walking, fighting, casting spells, or similar adventuring activity—the characters must begin the rest again to gain any benefit from it.

At the end of a long rest regain one (1) Hit Die. You may spend one (1) or more Hit Die to recover hit points. Hit dice spent at the completion of a long rest are rolled with advantage.

If during the past day you required sustenance and have consumed one days worth of both rations and water, then remove one level of exhaustion.

A character can’t benefit from more than one long rest in a 24-hour period, and a character must have at least 1 hit point at the start of the rest to gain its benefits.


And while much of the prior discussion applies, I’ve added a bit more.

Taken as a whole the above house rules:

  • Reduces the number of rounds of character incapacitation.
  • Maintains the tension of dropping to zero (0) hit points.
  • Reduces the tactical appeal of waiting for someone to drop to zero (0) hit points before healing them.
  • Slows down the healing cycle, which contributes towards modeling arduous journeys or the dangers of extended dungeon delving.

Why the change from the previous post? Simply put, this change streamlines the accounting. Death saves now fold into the exhaustion sub-system.

Why the extra step of exhaustion? In pushing the use of exhaustion into another sub-system of 5th Edition which sees heavy usage, I wanted to slow down the cumulative effect of exhaustion from different sources.

What remains? I vetted the previous rules with my game table. I will do the same for these.

I still plan to pursue a “Retreat” option. Something that removes you from combat. I think that this necessarily pairs with a chase mechanic and a regroup mechanic.

I think with a desire for retreat comes the need to require monster morale. Which has me think about codifying “end of round” procedures so that I have a script to follow while running at the game table. But that is a post for another time.