D&D 5E Death Saves & Pop-Up Healing

[TwoSix]

My current house rules I'm playtesting.

-Hit points go negative. When you get to negative your current max hit points, you die.
-When you go into the negatives, you are "Injured". When you become "Injured", you gain one level of exhaustion. Whenever you take an action, bonus action, or reaction other than Dodge or attempting to stabilize your wounds, roll a Death saving throw. If you fail, you gain an additional level of exhaustion.

It took exactly one bad fight with a PC gaining 3 levels of exhaustion before they started to actively seek out proactive healing and more defensive abilities. Players hate exhaustion.

 

[TwoSix]

An Extended Rest is 24 hours of uninterrupted bed rest in a safe location and counts as a Short and Long Rest. You regain all hit points, all hit dice, all class features, and may possibly reduce levels of Exhaustion you currently have. At the end of the Extended Rest another character may attempt a WIS (Medicine) check. A successful DC 10 check reduces your Exhaustion level by 1, a DC 20 check by 2 levels, and a DC 30 check by 3 levels.

Man, I just posted my house rules, but yours are way better. I'm stealing this.

One quick question about the above rule; I'm assuming the Medicine check is a graduated success, right? So if they get a 10, it's 1, if they get a 20 it's 2, etc. They don't have to target a level and then get an all-or-nothing result?

 

[Nefermandias]

It's a perennial problem with 5E. There's no lasting consequences of nearly dying. There's a lot of interesting house rules to solve the problem. This might just be one more to add to the pile, but I think it works well and solves a few problems without drastically changing much. There are changes to RAW, yes, but they're minor, I think. And the changes happen to solve a lot of related issues, I think.

So here goes...

Hit Points. When you reach 0 hit points, you continue fighting as normal, but you must make a death saving throw. Any damage you suffer while at 0 hit points automatically triggers a death saving throw.

Death Saving Throws. Roll a d20. If the roll is 10 or higher, you succeed. Otherwise, you fail. When you fail a death saving throw, you drop to 0 hit points and die.

This keeps characters on their feet and fighting longer (players get to keep playing the game), but risks outright death on a failed death save. No more pop-up healing as healing someone for one hit point because a pointless thing to do rather than the single most optimal thing to do.

If you wanted to make things even more deadly, you could introduce massive damage (more than 1/2 max hp) triggering a death save...or critical hits triggering a death save (hence the wording of the death save).

"lasting consequences of nearly dying" is achieved with the optional injuries table in the DMG.

That said, I confess I'd rather have an official variant for death at 0.

 

[Bolares]

Hit Points. When you reach 0 hit points, you continue fighting as normal, but you must make a death saving throw. Any damage you suffer while at 0 hit points automatically triggers a death saving throw.

This feels a lot to me like Darkest Dungeon's "death's door" system.

 

[DEFCON 1]

Man, I just posted my house rules, but yours are way better. I'm stealing this.

One quick question about the above rule; I'm assuming the Medicine check is a graduated success, right? So if they get a 10, it's 1, if they get a 20 it's 2, etc. They don't have to target a level and then get an all-or-nothing result?

Cool! Hope they work for you!

Yes, it is a graduated success and not all-or-nothing. The character nursing the Incapacitated character back to health just rolls after the Extended Rest and whatever they get they succeed with.

Something I didn't mention in the rules above (because like I said they are the same as the normal rules) include things like if a character is Stabilized but they then get hit again (if still at 0 HP) or lose the HP they have to return to 0 HP-- they are Incapacitated again and have to Stabilize again to avoid more death saves. And since Exhaustion doesn't go away even after HP healing, they pick up at the level they left off. So there is a slight "ping-pong" effect in play... but because the characters are never actually knocked unconscious until Level 5 Exhaustion, conceptually it doesn't feel as weird to me. All this stuff about Stabilizing and hit points etc. are all mechanics in the background, while in-story it's about characters becoming so tired and hurt they just can't swing their sword until they are helped out by a friend and given a slight boost of energy (or if we want to go the Warlord route, a boost of morale). They can still stagger away from battle, they just can't fight or cast spells until they receive that shot of adrenaline (aka are "stabilized".)

 

[Plaguescarred]

Hit Points. When you reach 0 hit points, you continue fighting as normal, but you must make a death saving throw.

Do you use the rule of nat 1 = 2 failures? What i dislike about making a Death Saving Throw upon dropping to 0 hit points is that it run the risk of ending up dead without anyone getting the chance to do something. If you fail a Death Saving save and your turns comes up right after your attacker's turn, in which you fail another Death save, and either of these failure is a 1, you die.

 

[Retreater]

I feeling like banning Healing Word would take care of many of the issues. Or maybe just make it effective only for characters who have at least 1 hp.

 

[jayoungr]

It's a perennial problem with 5E.

Seems to vary a lot by table. I regularly play with three different somewhat overlapping groups, and none of them are big on this, but then I hear from others on the board that it happens all the time for them.

 

[overgeeked]

Do you use the rule of nat 1 = 2 failures? What i dislike about making a Death Saving Throw upon dropping to 0 hit points is that it run the risk of ending up dead without anyone getting the chance to do something. If you fail a Death Saving save and your turns comes up right after your attacker's turn, in which you fail another Death save, and either of these failure is a 1, you die.

In my house rule there’s no multiple death saves. Fail one and you die.

 

[overgeeked]

I feeling like banning Healing Word would take care of many of the issues. Or maybe just make it effective only for characters who have at least 1 hp.

You‘d still have aasimar and paladin spot healing dropping 1 hp into someone.

 

[BookTenTiger]

Right now in my game I have two house rules to combat this:

1) Wound Points. You have a number of Wound Points equal to your starting HP at 1st Level. Every time you receive a Critical Hit, drop to 0 hp, or take damage while at 0 hp, or end a turn at 0 hp, you receive a Wound Point. If you have 0 Wound Points, you are dead. Half your total Wound Points are recharged during a Week of Downtime.

This has created a sort of countdown timer during adventures. The characters feel pretty confident at the beginning of adventures when they have all their Wound Points. But when those start to tick down, they get more cautious about combat!

2) Staggered. When you are at 0 hp, you are Staggered. You can only take an Action, Movement, or Bonus Action. You cannot concentrate on spells.

I'm thinking of replacing Staggered with Death Saving Throws. It could just be something like:

Death Saving Throw: when you start your turn at 0 Hit Points, make a Death Saving Throw. On a failure, lose 1 Wound Point.

 

[Retreater]

You‘d still have aasimar and paladin spot healing dropping 1 hp into someone.

That's true. But either of those would still have to move to the dying character and spend an action to restore 1 hp, instead of a bonus action, ranged heal.

 

[Ancalagon]

I saw an interesting house-rule, but I can't for the life of me remember where I saw it. But it was something like this....

Exhaustion: every time you drop to 0 hit points, you also gain a point of exhaustion. You still make death saves as normal, and you still die when you fail three of them (or stabilize when you succeed three of them), but that point of exhaustion remains. And they add up quickly.

I like that rule a lot

I would make sure that the exhaustion penalty doesn't apply to the death save though...

 

[OptionalRule]

I think the real take away is that the sheer amount of house ruling on the topic says something about the take on the design. We're all trying to fit to a bad cut here.

 

[Fanaelialae]

I think the real take away is that the sheer amount of house ruling on the topic says something about the take on the design. We're all trying to fit to a bad cut here.

I wouldn't read into it more than is there. This is a D&D message board. Folks here are going to be more inclined than the average player to fiddle with the rules.

I've considered house ruling it myself, but out of the three groups I play with I'm the only person who has. Let's not conflate mole hills with mountains.

 

[ad_hoc]

2 rules really transformed the game for me.

1. Failed death saves are not reset when you wake up. They only clear after a long rest.
2. You can't long rest on the road (I have rules for building a basecamp in the field)

These are good rules.

I have thought about using #1 but the table declined. One more thing can be added to make a death save as soon as hitting 0 so it isn't just a matter of healing them before their turn.

Also players at my table know that monsters will hit characters at 0 so they avoid it.

#2 is essential for overland travel. My rule is "long rest only at friendly settlements." Which is similar.

 

[Greg Benage]

I think the real take away is that the sheer amount of house ruling on the topic says something about the take on the design. We're all trying to fit to a bad cut here.

It's got problems, but I personally think a lot (read: all) of the fixes here dismiss some of its good features. At least for me, not requiring dedicated combat healers (or CLW wands) is a feature. Not having to worry about hit points until you run out of them is a feature. Not having to worry about death spirals is a feature.

The whole game is designed around resource attrition, so that's the lever I pull to create a sense of danger and risk of death. I don't also need to increase my chances of killing your character outright halfway through a battle to get that.

 

[DEFCON 1]

I think the real take away is that the sheer amount of house ruling on the topic says something about the take on the design. We're all trying to fit to a bad cut here.

People don't house rule only because the written rules are bad. People also house rule to keep things from getting boring. Or to better emulate a certain experience. Or to exercise their own design skills. Or because they know worrying about "Rules As Written" is a bad habit, and anything they can do to stop people focusing on that bad habit is good for the game on the whole.

 

[OptionalRule]

I personally think a lot (read: all) of the fixes here dismiss some of its good features.

How are all the replies here dismissing that?

 

[OptionalRule]

People don't house rule only because the written rules are bad. People also house rule to keep things from getting boring. Or to better emulate a certain experience. Or to exercise their own design skills. Or because they know worrying about "Rules As Written" is a bad habit, and anything they can do to stop people focusing on that bad habit is good for the game on the whole.

Of course. The original point still stands. If there wasn't a fit problem with death saves we would see those house rules spread across an equal number of systems. A few subsystems seem to get the vast majority of focus in terms of house rules.