From my perspective, if I was to add in 'long-term effects' to PCs getting hurt... I would definitely make them *new* complications, and not things that they already get as part and parcel with normal debuffed adventuring. Simply because debuffs don't solve the perceptual problem in my mind.
So for instance... "level drain" causing a stacking -1 to hit, -1 to skill checks and -3 hit points debuff is no different than the same debuffs a monster might do to the PC during a normal combat. If a monster's attack debuffs the PC by giving him a -2 to hit until the end of the monster's next turn (and the monster basically tries to refresh the debuff every other turn)... stacking that with an additional -1 for "level drain" does not really mean that much perceptually to me. It's just one more modifier to calculate. "Level drain" as a concept just loses a lot of emotional impact.
So I'd want to have completely new rules created that are not and will not be duplicated by any other standard effect that can come up in the game. So for example just off the top of my head... once a PC drops to 0 HPs during an encounter, once the encounter is over they can now only regain HP via healing surges up to 3/4ths of their total HP (basically their Max HP becomes 3/4ths their normal value). If they drop to 0 a second time, they can only get healed up to their Bloodied value. Third time, 1/4th. Fourth time, best they can do is stabilize at 0. And this doesn't go away until an Extended Rest if you're being nice... or Extended week-long bedrest if you want it more hardcore.
There's probably a bunch of other mechanics you could design that would fit into this space... but I would definitely want whatever was used to be an original mechanic and not anything that is used in another part of the game. Make those long-term effects have an emotional impact on the player.
So for instance... "level drain" causing a stacking -1 to hit, -1 to skill checks and -3 hit points debuff is no different than the same debuffs a monster might do to the PC during a normal combat. If a monster's attack debuffs the PC by giving him a -2 to hit until the end of the monster's next turn (and the monster basically tries to refresh the debuff every other turn)... stacking that with an additional -1 for "level drain" does not really mean that much perceptually to me. It's just one more modifier to calculate. "Level drain" as a concept just loses a lot of emotional impact.
So I'd want to have completely new rules created that are not and will not be duplicated by any other standard effect that can come up in the game. So for example just off the top of my head... once a PC drops to 0 HPs during an encounter, once the encounter is over they can now only regain HP via healing surges up to 3/4ths of their total HP (basically their Max HP becomes 3/4ths their normal value). If they drop to 0 a second time, they can only get healed up to their Bloodied value. Third time, 1/4th. Fourth time, best they can do is stabilize at 0. And this doesn't go away until an Extended Rest if you're being nice... or Extended week-long bedrest if you want it more hardcore.
There's probably a bunch of other mechanics you could design that would fit into this space... but I would definitely want whatever was used to be an original mechanic and not anything that is used in another part of the game. Make those long-term effects have an emotional impact on the player.
