D&D 5E A Simple Way of using the Lingering Injuries Table

Our twist is to do a minor 'Lingering Wound' on dropping to 0 from a lethal attack by rolling one of your HD and subtracting the result from your Maximum hit points (like some of the undead do). It recovers on a Long Rest or with magical healing. (Representing injuries which can knock you out of a fight temporarily or potentially kill you - shock, flesh wounds, concussions)

If you roll a '1' (the minimum result) you instead roll on the DMG Lingering Wounds table with the severity based on the situation (for example a level 2 monk fighting a wildshaped goblin druid - a black bear, had his arm injured requiring a lengthy recovery). So far actual injuries are rare but memorable.
 

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Personally I would treat monsters the same as PCs for death saves, then give people a lingering wound the first time they are brought below 0 in a fight and any time they take a critical hit while down.

In particular the first rule has led to one of my PCs almost being killed by an assassin while he was looting him (the assassin happened to roll a 20 on his death save just as the PC was rifling through his pockets) which was pretty memorable. It will also lead to long running recurring foes (for good and ill), and the lingering wounds stuff will add to that.

I remove the horrific scar game mechanics though, because they're silly.
 


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