Hurt, broken, sliced and torn – long term damage in RPGs or lack thereof


RPG combat wounds are boring (usually “lose hit points” which means either “nothing” or “you lost your last one, gg”) and unrealistic because most people short term don’t want their player agency impacted, and long-term don’t want to play crippled characters, or don’t want their character to die in their bed. Those who want to play crippled characters are ok with long term wounds, but the real consequences of wounds can be unfun even for them. And magical healing can either do nothing against these long-term consequences, or fix them at a leisurely speed and make them immaterial, as if they never happened.

I have a few examples here of scenarios that are totally realistic. Well, the first scenario happened to me.

Case 1 – Broken

Last year, while bouldering, I fell. From the proverbial 10′ up. Breathless, squirming on the ground for a minute, was overcome by the pain.

Then I got on my feet, shrugged it off and kept on climbing for hours.

That night the pain kept me awake quite a bit. Bad bruise.

And it kept on keeping me awake. Breathing was painful. Walking was painful. Getting dressed was so painful. Don’t get me started on putting on shoes. I was basically in pain all the time and severely impaired by it. Every movement, iincluding breathing, was hard or impossible.

Case 2 – Sliced

Andrea is a soldier, and gets bayonetted in the arm. Andrea manages to stab their opponent in the face, and survives. But who knows where that bayonette has been, and Andrea wound gets infected. The wound is septic, but the arm is perfectly usable. The army medic amputates the arm, because Andrea gets worse and worse and does not want to die. Andrea is now an armless war invalid.

Case 3 – Torn

Jools is a dragoon, currently busy in a mounted charge against a unit of musketmen. The crossbowmen shot them, and bullets bounce off her cuirass. As the charge connects, mayhem ensues as per use, and Jools somehow gets shot in the lower back. Nothing dramatic, as they manage to get back on their feet, win the battle and route the enemy, and the wound gets treated, but the wound is really deep and the bullet perforated bowels and Jools dies of sepsis a few days later.


The consequences of damage could be more varied. Your characters could end up in one of the three above scenarios: fine but later one of the following:

  • medium-term disabled
  • permanently disabled
  • totally dead

I have the above results in my critical hit tables. I had player characters suffer those outcomes.

Sometimes they had magical healing staving off long-term death: as if it never happened, because “you’re going to die in 3 days/be invalid from wounds surgery can’t fix” means nothing if you can get magic healing before the PC dies.

Some other times, people were left with no limbs or eyes, or bedridden because they had no access to magic or modern healing. Players abandoned their characters. Hell, once a player abandoned the campaign after their PC lost an eye playing with a black pudding. At level 2.

The Gamable Part – And lack thereof

There is no good gamable part in this post, sorry. I think it’s kind of useless. So instead you get a rubbish table.

Every time a pc gets a critical hit or they are dropped to zero (depending on the august Referee), roll 1d4 in secret on this following “Long Term Additional Damage Table” after the combat, and then roll a hidden save: if the save passes, nothing happens. If not, this is what happens:

  1. hurt. Nothing beside the wound itself
  2. broken. In 1d6 hours you’re borderline paralysed, or can’t use a limb (roll at random). Lasts for (3d6 drop highest) weeks.
  3. sliced. One of the wounds on your limb is festering. In 1d6 days, unless amputated, save or die.
  4. torn. Something went bad with that wound to your head/torso/abdomen. Sepsis is going to kill you in 2d4 days.

Magic healing fixes these problems.

Case 1 – Followup and reflection

I went to the hospital because after a month that bruise was still hurting a lot.

Turn out? I broke two ribs, and while I had scores of bike crashes and motorbike accidents (mostly because people driving cars only dodge pedestrians and cars) I never broke anything (I’m seriously not a frail person) so, what are the chances, right? I broke two ribs because when I fell on the security mat I connected with my elbow, and my ribcage banged on my elbow, and elbows are damn hard. Harder than ribs. My elbow was fine all the time.

This is the poster child of the argument, for me. I fell and took 1d6 damage. I was fine climbing until nightfall, then more or less useless at most physical stuff for a month. I could not dodge an attack. I had effectively 1 hit point for weeks, as was not in shape for dodging in melee, and pretty much any amount of shuggling would just make me bowl over.

Maybe the only good part about not dying the now on a critical hit is that you get to fight for a few more rounds and kill the opponent. So, you win, but you’re going to die anyway. Grim.

14 thoughts on “Hurt, broken, sliced and torn – long term damage in RPGs or lack thereof

  1. In Dungeon Crawl Classics, for every 10′ you fall, you take 1d6 damage. On a 6 you break a bone. Easy.

    Also, crits can cause long-lasting or permanent injuries. This applies to both PCs and everything the PCs might hit.

  2. Hmmm, so, that’s a really good point that “more realistic” (or at least harsher) wounding/critical hit rules might not have that much utility in a game once they happen.

    I can think of two purposes they might serve, though, that are sort of related. First, they provide a psychologically scarier consequence to combat than “you make a new character.” Or at least I suspect it’s scarier to be told “this guy you’ve gotten attached to is now horribly changed” rather than “make a new guy to get attached to”. So it has a sort of negative space effect – people might engage with the question of “to fight or not to fight?” differently when maiming and wounding are on the line rather than yes/no effectiveness.

    Related to that is the idea that horrible injuries are actually a way of making characters *more* robust than 0HP = dead. I think if you’re more on board with this one, you probably weight your criticals towards lots of temporary effects (like getting winded or knocked out) and fewer towards gruesome permanent injuries.

    Does any of that make sense? Or am I wandering into unrelated territory?

  3. I’m rather more inclined to treat a fight in an RPG as a process of making your opponents stop fighting. Anything that stops a participant being able to fight on would therefore count. Sometimes it’s a blow that leaves you temporarily unable to fight, sometimes it’s a degree of panic that leaves you running away or snivelling on the floor, and sometimes it’s death. What that is, and whether there are any permanent consequences for the losers or winners, isn’t necessarily something you resolve till after the fight – I’d argue that’s the most appropriate time, when people have had a chance to check what’s actually wrong rather than relying on adrenaline to keep them going.

    One thing I do object to is your statement that, “Magic healing fixes these problems.” Not all RPGs are fantasy and have magic. And not all GMs want a game where the importance of magic is even more inflated than in default D&D.

    • regarding the “stopping the opponent”, the truth is that most injuries that you inflict on people do not kill them within a few minutes, but will definitely kill them in due time. Mostly of infection, or internal bleeding. We don’t really care about them for monsters (because we usually don’t really care about what happens after the combat for them), but I rarely ever saw a PC killed by sepsis. Let’s look at the utility: is death by sepsis something that increases fun? I’m not sure.

      And of course if magic is not there it can’t fix problems… and it doesn’t make “magic fixes problems” invalid. It means that without magic or sufficiently advanced technology you’d bele ft with a disabled character, of which I littered my campaigns (especially) because I often play games with magic that is not as widely available (Chthonic Codex is an outlier).

  4. Obviously, it all depends on the game’s tone, but I like the idea of using critical failures to cause more important injuries.

    To me, most action-oriented games basically used movie logic/physics/biology. Heroes shrug off bullet wounds all the time. A limp disappears between scenes. It’s par for the course and takes much less book-keeping. If your game is particularly gritty, you would want to make damage more grisly, detailed and permanent. I’d do that in a realistic war story, for example, or in horror games. And in fact, if the game ISN’T action-oriented, I think damage should be especially nasty, because violence is NOT meant to be a viable solution and players should be taught that early on.

    I also had a meta-textual thought about this yesterday and it wind up on my blog. Just gonna give you the link if you’re interested: – a wider-ranging discussion, but combat damage is definitely a part of it.

    • Mmmh, good post. It makes me think.
      First and foremost is that we could probably pick and mix more the ruleset depending on what we expect at the table.
      Second, possibly there’s an interesting design space there for entourage games using badly mutilated, retired ex-adventurers as advisers, craftsmen, guards, etc.

      • Oh man, you’re making want to run some kind of “Crippled Avengers” mini-campaign (ever seen that kung fu movie? it’s pretty crazy).

          • Don’t think I won’t! I may be worth resurrecting my Hong Kong Action Theater group for that one-off. I think the last game we played was a Shaolin Hockey story called Pucks of Fury, so you know they’d be up for it!

  5. A few months ago. had a fall at work I was bed-ridden for 3-4weeks, “all” I had was a bruised spine and while I’mback to doing normal stuff I am still not 100%, recovering from the inactivity of recovering takes a while.

    If you want to reflect long-term wounds hit folks where it hurts: lower ability scores. All the mechanis for having a lower score are already in place and players will notice the change again and again.

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