We are gonna talk DnD 5e for a second here. More specifically lets talk about what happens when a PC hits zero HP. Rules as written (RAW) means the character is unconscious and begins the death saving throw cycle. This can mean the beginning of the ‘death spiral’ for a party, a term I’m sure you’ve heard before, where the action economy of the players is reduced by the loss of the party member (and whoever tries to stabilise them) and all of the characters become vulnerable as they are out numbered by enemy actions.
The result; Total party killed (TPK). This is what it looks like and this is how it starts. I’m not suggesting that this is bad or broken in any way. I’m here to offer some tweaks that could be made to make TPK less likely, to increase the drama, to potentially simulate ‘medical’ intervention more accurately and to allow a player to add to their characters story:
- Lasting injury – When a character is reduced to zero HP rather than saying they are unconscious allow the player to take on a ‘lasting injury’ and continue to remain able to act until they take damage again. There is such a table at the back of the DMs guide but it is limited and not damage-type specific. There are many to choose from that are free online or you can purchase in the DMs Guild. They vary wildly in quality and you might have to search for a good one. These lingering injuries should be lasting (as the name suggests) and not be easily healed. If done well it could add to a characters’ individuality and assist in richer role playing.
- How to save a life – Successful use of medicine skill (with or without an aid kit) stabilises a downed character in the RAW. Why not allow the successful use of medicine skill to only negate failed death saves. This would mean that a the player would still need to succeed to stay alive and the first-aider would only be able to assist by removing failed saves. This could create a more dramatic sequence where the aid-giver is fighting back death as the downed character struggles to survive. This also would more accurately simulate the loss to the action economy of the party as the character giving aid would be dedicated to the act of saving the life of the character.
- Fog of death – Roll death saves in private (the DM may be included or not depending on your group and the level of trust you have in your players) and only reveal when another character intervenes or can examine the downed character. This will build tension by the party not knowing how long they have to revive a character and not know if they have died or stabilised.
Three Tweaks 