There are basically two types of wound in Rolemaster. You have your general "concussive hits" which fulfill the role of hit points in D&D. If you manage to lose all of them, you die. Until then, your combat effectiveness isn't impaired - that's if I remember correctly, for it has been quite a while since I've played Rolemaster.
However, more significant than CP are Critical Hits, which provide actual descriptions of the wounds you suffer. It's been observed that hitting people doesn't kill people in RM, crits kill people. It's an observation I agree with. So, you can get a "thigh wound" which reduces your movement by 25% until healed - either through rest or curative magic.
In RM, combat is a bit too deadly for my liking, and it certainly has the death spiral effect, where hits impair your abilities so much that you can't come back.
In RM, concussion hits
do model the ability to withstand cuts, bruising etc. They are also what is lost from bleeding wounds (eg an arrow might cause bleeding of 3/round). Losing all concussion hits means unconsciousness; death comes when negative hits are equal to CON score (typically 60 to 100 for a PC). Starting hits for a PC are around 10 to 50, depending on class and edition, and maximum hits for a human are around 175 (usually achieved by a PC fighter somewhere between 10th and 20th level, depending on edition and the details of the character build).
So a character with 100 CON and 175 hits can take 275 hits before dying, about 3 times that of a typical starting PC (30 hits, 70 CON). But s/he can take many more hits than the low level PC before falling unconscious (about 9 times as many).
To get a sense of what these numbers mean, an average attack with a sword against an unarmoured person can easily deal 30 or more hits as well as fairly serious critical damage.
HARP uses a similar concussion hit mechanic to RM, although PC hit totals are likely to be slightly lower.
RQ uses hit points as a measure of physical toughness. It's been a while for me, but I think that hit points equals average of CON and SIZE, so will typically be somewhere between 10 and 16 for a starting PC. Weapons deal damage comparable to D&D, but armour reduces damage, so (for example) it is quite hard to hurt an armoured person with a dagger.
Most basic roleplaying systems (Stormbringer, Cthulhu etc) use a similar approach. In RQ, and unlike most of those other games, hit points are applied not only to the general pool but to particular locations, and when a location takes more than a certain amount of damage it is weakened or destroyed (and destroying the head causes death even if the character has hit points remaining).
These are the main simulationist damage mechanics that I'm familiar with. I think Chivalry & Sorcery and HERO use something similar to RQ but without the hit location, and I think both also distinguish lethal from non-lethal damage, which come from separate pools.
In most of those systems, the effects of damage were pretty severe. The main point was that you needed to avoid being hit in the first place, and they'd give mechanisms to allow to you to do that: Hero Points in James Bond, really high Dodge scores and Force Points in Star Wars. If you got hit, you were actually hit.
In RM you avoid getting hit by parrying. In RQ and HARP, by parrying or dodging. The difference between RM and HARP on the one hand, and RQ on the other, is that parrying involves a trade-off against attack (a little like 3E combat expertise) and thus requires the player to make choices round-by-round about the sorts of risks her or his PC will take.
In HARP there is also a Fate Point mechanic for increasing defence, or for reducing damage once a foe's attack has been resolved.
D&D has a simpler system where the mechanism for avoiding being hit is also part of the hit point system. If you get "hit" for 40 hp - enough damage to kill a horse - and you still have 40 hp, then we say you weren't actually hit after all. Healing Surges are indeed confusing the issue
A system that is quite non-simulationist in its action resolution mechanics is HeroWars - conflicts are resolved by the player and the GM each staking a certain number of "action points", and then gaining or losing these depending on the result of their die rolls, and only once one side has lost all its action points is the outcome known and any wound penalties to future conflicts accrued by the losing character. The rulebooks have good advice on how to narrate this conflict so that the narration doesn't foreclose future possibilities that the rules leave open. For example, it is always possible that a PC might come back from even a very serious action point loss, and so it would be a mistake to narrate that as a grievious wound until it is known that the battle is lost.
A comparison here is Frodo getting stabbed by the spear in Moria - we know that a heavy blow was struck by the orc chief, but we don't know what it's effect on Frodo was to the end, at which point we discovered that his mithril armour saved him.
So in 4e, as Herremann the Wise has pointed out, it is possible for a PC to be in a state where (according to the mechanics) either s/he is dead in 18 seconds, or s/he is up and fighting again in 6 seconds. How to narrate that? Not in a way that excludes either possibility - thus one might refer to the character having fallen with a spray of blood from her face, but only after the death saves have all been rolled and any healing surges applied does the narration firm up, either to "You see now that her skull has been staved in" or "Wiping from her eyes the blood flowing from the gash in her forehead, she gathers her resolve, stands and returns to the fray."
After a five minute rest, depending on whether or not the PC has healing surges to apply, we can then go further: either "The blood flow stops, but the cut is deep and will easily reopen" if she has no surges to apply and is therefore close to going down in the next fight, or "Some water washes the wound clean as the blood stops flowing. Luckily it was only a surface injury - with any luck it won't trouble her any more."
As to the main issue: is it an objection that the mechanics don't dictate to the players and GM exactly how the gameworld should be described? It depends what sort of experience you want out of playing an RPG. If you want the game to tell you a story, it probably is an objection. If you want to use the game to tell a story, then it's probably a virtue that the mechanics seed a story (via setting paramters) without dictating one.
