AtomicPope
Hero
what happen if they go down again ? 1 more Exhaustion ?
Yes. Exhaustion acts like a Wound Track where injuries seem almost permanent. Typically what happens 5e combat when a PC is reduced to 0 hit points is a 1st level Healing Word is cast, then they pop back up. Grievous Wounds encourages the players to invest resources healing otherwise they're sending a party member off to certain death. In a few Boss fights the PCs hobbled away with a couple levels of Exhaustion adding a little drama to the game. Getting one level of Exhaustion isn't too bad since a long rest will remove it and the PC is just a little sluggish. Getting two or three levels is crippling. If you have four levels of Exhaustion you're on Death's Door. The first time they'll let it slide until the full weight of their injuries sets in. Once experience several "injuries" they'll be more vigilant.
My campaign has been going strong for a little over 3 years. The Grievous Wounds house rule has been in effect since day one. It's important the players get familiar with the rules so there are no surprises. I remind the players that Exhaustion Levels will impose Disadvantage on Saving Throws, that includes Death Saves. I remember one particular adventure where several of the PCs failed save after save and the AOE damage spread quickly. Everyone but the Ranger dropped to 0 hit points. She used Cure Words to bring back the Cleric and her Eagle pet used its action to heal another PC with a potion. The Cleric was dropped again, then brought back up. All told the Rogue was dropped three times, the Cleric twice (maybe thrice but I don't remember), and the Ranger and Fighter once. When the Ranger dropped they just had to try and kill the monster before she died since her pet was obliterated in the AOE. They were in a cavern full of Ghouls and Ghasts, and even though they were 10th level their Exhaustion Levels made them think twice about hacking and slashing their way out. They found a small crevasse and hid inside to rest while the Elven Ranger stood watch.
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