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.