I’ve long been a fan of Trollsmyth’s Death & Dismemberment table for D&D-like games… Arduin’s Critical Hits are more amusing, but quite a bit deadlier than I’m usually willing to play with (though I read somewhere recently that the way Dave Hargrave used them they were only 1 in 400 chance… a 20 followed by a 20 required a roll on the Crit Chart, rather than just a 20 the way we did back in High School.) At any rate, one of the things that kind of bothers me about 5e Basic is that there’s not really any way to sustain a real injury. I’m OK with Hit Points representing pure Stamina, or at least I’m willing to give it a try and see how my players like it, but it kind of bugs me that except by GM fiat there really isn’t any way to suffer a broken bone or serious laceration. Even if your HP go to 0 and you have to start making saves against Death, once you’ve stabilized a Long Rest will patch you right up.
So my current thought is to use a slightly modified version of Trollsmyth’s D&D chart to fix that. We’ll ignore the time-to-death results from the original chart, and just use the 5e three success before three failure Death save to determine when and if you die.
If you get taken down to 0 HP, and every time you get hit when you’re at 0 HP, roll on the following table. Apply a -1 modifier to the die roll for each time you’ve failed your Death save, a +1 for each success.
|2 or lower||Grievous wound: Increase Exhaustion Level by 5, if that would take you to 6 Instant Death (decapitation or the like).|
|3||Fatal wound (gutted, stabbed through lung, broken back, etc.); Increase Exhaustion Level by 4.|
|4||Severed limb (DM’s choice or roll randomly); Increase Exhaustion Level by 3.|
|5,6||Severe Wound. Needs surgery. Increase Exhaustion Level by 3.|
|7,8||Broken bone (DM’s choice or roll, randomly); Increase Exhaustion Level by 2. Requires 2d4+9 weeks to heal; can’t use the bone until that first 2d4 weeks have passed. After that are at a Disadvantage for checks that rely on it until it’s healed the rest of the way.|
|9||Moderate Wound. It’s going to need stitches. Increase Exhaustion Level by 2.|
|10||Light wound: cut, gash, contusion in random place, and according to weapon type. Needs bandaging. Increase Exhaustion Level by 1.|
|11||Knocked out for 2d6 rounds, unless wearing a helm. With helm, only stunned for 1 round. Increase Exhaustion Level by 1.|
|12+||a surge of adrenaline returns 1d4 hit points per HD; these vanish at the end of combat & you gain 1 level of Exhaustion.|
The upshot of using this table is pretty much anything that takes you to 0 HP will also give you at least one level of Exhaustion… I think that’s fair for an ever so slightly grittier take one what it means to be out of HP and dying. If you want to stick to straight 5e for HP and conditions, you could just use the wounds as flavor text with no mechanical effect.
For an even grittier, though still not super-gritty, effect you can also use the table for critical hits in a variant on the Hargrave method: a crit is double damage, and 1/20 chance of having to roll on this or some other favorite critical hit table.
And as an added bonus, I’m reposting the Quick Hit Location Chart I posted on G+ a little while back, which lets you quickly determine a hit location without an extra die roll, and a relatively sensible weighting of heavier hits with more dangerous places: