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It stops being rediculous when you consider the fact that 0 hit points doesn't necessarily mean "laying on the floor". There's no reason to assume that after taking a sword to the gut, your character next finds himself laying on his back, sleeping. It's more reasonable to assume he's dropped to a knee, or otherwise hunched over in pain, too wounded act. It's pretty reasonable to assume that if his gut wound were somehow suddenly magically healed, he could stand up rather quickly and get back into the action.

If the rules didn't define 0 hp as unconscious this would be more applicable.
 

I think I'm going to reward 0 hit points with a level of exhaustion. I'm curious what rules the DMG is going to have for lingering wounds.

That would be doubly brutal in my game, since I already count exhaustion levels against long rest HD recovery. I think the exhaustion rules are great but that might turn them into a death spiral mechanic.

The trouble is it effects different classes differently. Our bard has only gone down once, the monk has dropped in every fight but one, often to a single hit from a bugbear. Those guys are brutal.

If you want to slow things down though it's a great idea. However my players seem to feel a good deal of time pressure in their desire to rescue Gundrun, and I don't want to penalize them for RPing that kind of loyalty to an NPC they've never actually seen "on screen."
 

That would be doubly brutal in my game, since I already count exhaustion levels against long rest HD recovery. I think the exhaustion rules are great but that might turn them into a death spiral mechanic.

The trouble is it effects different classes differently. Our bard has only gone down once, the monk has dropped in every fight but one, often to a single hit from a bugbear. Those guys are brutal.

If you want to slow things down though it's a great idea. However my players seem to feel a good deal of time pressure in their desire to rescue Gundrun, and I don't want to penalize them for RPing that kind of loyalty to an NPC they've never actually seen "on screen."

Since I want to make combat more deadly, serious wounds have lasting effects and healing require longer downtime periods, I'm okay with that. We're used to (and prefer) games where it's far easier to die and full recovery takes more time than a full rest. I could have went with slowing down HP recovery, but that's easily avoided with magic and it's far less interesting. I was thinking about adding Wound levels too, but Exhaustion handles that pretty well already with it's effects.
 
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Depending on how things go the first couple of sessions, I presume I will be using the same type of in-game "story" for the loss of hit points that I did in 4E.

- Despite the name of the condition being 'Unconscious'... PC will not actually black out each and every time they drop to 0 HP. They'll drop to their knees or fall to the ground, just so exhausted or beat up that they lose all the actions and abilities that the 'Unconscious' condition takes away. They just won't be actually unconscious, because I find that with the yo-yo, going back and forth between conscious and unconscious repeatedly during a fight to be rather silly.

- I'll really have to think about whether or not I want to have Death Saves reset after regaining hit points in the middle of combat. My first impulse is to follow 4E's rule and say that no, they don't reset even after being healed just so there's more of a risk to the PCs. But with the new Short Rest rules being an hour rather than 5 minutes... I dunno if I really want to invent a new time period of "after the fight" where they reset. To follow the established game conventions it should be after a Short Rest... but I'm fearful that might inspire more inopportune requests from players for Short Rests because players are afraid of going into new fights down a failed Death Save or two. But at the same time... the more healing you have in the party, the less likely you'll ever see PCs begin to actually make Death Saves anyway before getting healed, which makes a '3 strikes' rule almost unnecessary to keep track of because it'll almost never be an issue-- the count keeps getting reset before getting past like the first failure.

- One final thing I think I might do just to not make the Medicine skill completely useless is to say that the Healer's Kit either can't be used in the middle of combat (thus all in-combat stablization has to come from PCs making Medicine checks or Spare The Dying)... or that the Healer's Kit allows a Wisdom (Medicine) check to be made with Advantage. I suspect that is the direction I'm going to go. I don't like the idea of a piece of equipment just completely removing the necessity of a Skill from the game. They should have made the Healer's Kit a Tool that you needed proficiency in and not included the Medicine skill at all if that was going to be the case.
 

As an alternative to other suggestions, I was contemplating a house rule to have any damage that takes you below 0 HP reduce your maximum hit points by an equal amount. As always, if maximum HP is reduced to 0, you die. Still deciding on how quickly I'd want your maximum HP to return (level plus Constitution modifier per day, perhaps), and whether or not to replace death saves entirely (Constitution save or take 1d6 damage each round, which translates to 1d6 reduction in maximum HP).

Still a work in progress, but it might be an interesting (and scary) option to try.
 

One final thing I think I might do just to not make the Medicine skill completely useless is to say that the Healer's Kit either can't be used in the middle of combat (thus all in-combat stablization has to come from PCs making Medicine checks or Spare The Dying)... or that the Healer's Kit allows a Wisdom (Medicine) check to be made with Advantage. I suspect that is the direction I'm going to go. I don't like the idea of a piece of equipment just completely removing the necessity of a Skill from the game. They should have made the Healer's Kit a Tool that you needed proficiency in and not included the Medicine skill at all if that was going to be the case.

I went the other way with that and just stripped the Medicine skill out of my game. It's essentially completely useless.

Since I want to make combat more deadly, serious wounds have lasting effects and healing require longer downtime periods, I'm okay with that. We're used to (and prefer) games where it's far easier to die and full recovery takes more time than a full rest. I could have went with slowing down HP recovery, but that's easily avoided with magic and it's far less interesting. I was thinking about adding Wound levels too, but Exhaustion handles that pretty well already with it's effects.

Yeah, it's not a bad rule. It's just that it gives you a hard cap on getting dropped no more than 5 times a day before you had damned well call it a night. If you get knocked down a 6th time the exhaustion level from saving you will kill you!

I might put in a saving throw to prevent the exhaustion. Or... Hmmm. Perhaps I could revitalize the Healing skill by allowing a check on downed character to not just stabilize but to offset the exhaustion penalty. Then you have a choice to make as a party in dealing with a downed friend. Bring him back now, but add to his long term risk, or spend a few moments making sure his organs are all lined up correctly before you run a 1000 amps of positive energy through his carcass. Huh, I kind of like that. It's too big a change to make mid game, but if I were to start a new campaign, I might institute that rule. Probably give it a decent difficulty too, to make the skill worth taking, 15 perhaps.

I'm really curious to see how close some of the DMG options come to what we are kicking around. I suspect very close.
 

Yeah, it's not a bad rule. It's just that it gives you a hard cap on getting dropped no more than 5 times a day before you had damned well call it a night. If you get knocked down a 6th time the exhaustion level from saving you will kill you!

And it's still much more than in previous campaigns, where getting knocked down even once mostly meant rolling new characters. ;) It's a matter of taste, but I like when players are more careful about resources and getting into battles.
 

[MENTION=1879]Andor[/MENTION], another possible option would be just to say that you don't gain the level of exhaustion when you drop, but rather after you fail a specific number of death saves. If you want it to happen more often, they pick it up after the first failed death save; if you want it less often in your campaign, after the second.

That way there's still the risk, but it's not happening each and every time a character drops.
 

My house rule is just that you don't return to consciousness immediately upon reaching 1hp - when injury drops you to 0 or below, you fall unconscious for (1d4+1) minutes, even if you receive healing.
 

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