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Here is the latest version of my "Wounded" system. I'd love any further feedback you care to give.

There are two possible ways for a PC to become Wounded:

A PC who fails a Death Save while at negative Hit Points becomes Wounded.

Certain monsters (mostly Elite and Solo monsters) or Traps may cause a PC to become Wounded on a Critical Hit.

While Wounded a PC suffers from the following effects:

They do not regain full hit points after an Extended Rest. A successful Heal check after an Extended Rest allows them to regain hit points as though they had spent a Healing Surge.

The PC is not as resiliant as normal and thus their healing surges only restore half (rounded down) of the normal hit points.

A character may attempt to recover from being Wounded after an Extended Rest by making a successful Endurance check. If the PC is under the care of a character Trained in the Heal skill, that roll may be substituted for the Endurance check. In addition it is possible for certain Rituals to give bonuses to this Endurance check or to heal the Wounded condition outright.


This would mean that a Wounded PC IS effected in Combat by way of not gaining as much benefit from healing effects. It also means that having a Cleric around helps quite a bit (thanks to the extra healing above and beyond the Surge value for Healing Word). Without a Cleric a PC has to spend (roughly) 8 Healing Surges to be at full health from zero. That's going to be the lion's share of Surges for even the strongest members of the party.

It makes a Wounded PC fragile and less able to recover from nastier wounds but doesn't take them out of the fight entirely. I think that's the feel that I'm after here.

Mechanically it requires no additional tracking that you weren't already doing anyway during combat. And it takes only a single roll to determine whether the PC has recovered after an Extended Rest.