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D&D Next Design Idea: Wounds and Natural Healing

Ever since the last time I wrote about healing in D&D Next, I've been rolling ideas around in the cavernous emptiness of this here melon. I'm still not happy with healing solutions that involve no attrition at all over the course of an adventure, but my stance has softened somewhat from thinking more about how natural healing works in a Ro3 LARP. Importantly, fifteen to sixty minutes of time in a LARP means a lot more than fifteen to sixty fast-forwarded minutes of tabletop gaming, and the inconvenience of being wounded sinks in for the player to a much greater degree. Still, on that basis I could be okay with someone getting knocked unconscious and recovering well enough to fight again through strictly natural healing, and given how cinematic other rules are tuned to be, I'm okay with someone who has sunk some character power into nonmagical healing getting really quite good at it.

At the same time, I'm not okay with zero-cost natural healing in tabletop, but there's not an immediately evident currency to pay with beyond Hit Dice, and those run out quickly. The Administer First Aid skill (digression: what the hell is up with that skill name? You're too good to call it Heal, Physick, or Medicine? Good grief) can stabilize the dying and gather information about various horrible things that might be wrong with you. It can't otherwise do anything at all to restore hit points, cure disease, or treat poison... so why would you spend one of your precious skill slots on this, when a cleric can fully match that ability with the detect poison and cure minor wounds spells (and, of course, no chance of failure)?

In that earlier post on healing, I brushed on past the idea of SIFRP-style Injuries and Wounds. I started plotting that out, but the numbers weren't working out to fit D&D's general scheme, since low-level characters are nowhere near as badass as a starting SIFRP character. I set the idea down for awhile, but recently it came back to me in a kind of... inverted way. I want to preface this by saying that it may totally not work at all. This is a multi-part thing, so bear with me. This is intended for more robust out-of-combat healing only.

Restoring Hit Dice

Natural healing still occurs through spending Hit Dice outside of combat. Low- to mid-level characters in particular need that extra out-of-combat healing to keep going for multiple encounters in a day; even at higher levels, the spellcasters should be saving their spells for in-combat healing. Therefore I'd like to see a way to restore Hit Dice in the span of a day, and this is where the inversion of the Injuries/Wounds idea comes in. Instead of taking an Injury or Wound in place of hit point damage during the fight, the battlefield medic uses a healer's kit to patch up your injuries and get you up and moving again. Those wounds might get reopened in combat, though, and if that happens you're worse off than if you'd taken a hit while uninjured.

In addition to using a healer's kit to allow a character to spend Hit Dice for healing, a character can use a healer's kit to restore spent HD by giving a character (partially-healed) Wounds. The character can immediately spend the restored HD to heal damage.


Characters can have a number of Wounds equal to the maximum value of their Hit Die (possible variation: "...plus their Con bonus"). When the character takes damage from any non-ongoing source (here presuming that D&D will eventually add more damage over time effects), the player rolls a die of the same type as her Hit Die. If the result is less than or equal to the character's current number of wounds, the character takes 5 additional damage. (Again, a possible variation is "...player rolls a die of the same type as her Hit Die and adds her Constitution modifier, if positive." This would let tough characters endure quite a few more Wounds before being at any risk.)

After a long rest, characters can make one Constitution saving throw per Wound, with a DC equal to 10 + the current number of Wounds. On a success, the Wound is removed. A character trained in Administer First Aid can substitute a skill check in place of one or more of these Wounds; each substituted check costs one use from a healer's kit.

More Options for Administer First Aid

I think the current list of options for administering first aid is pretty thin, as I mentioned above, considering the rarity of trained skills in the current iteration of D&D Next. I realize the system has stayed pretty light on specific skill applications, but it's hard not to get just as crunchy on healing damage as the system is on dealing damage. (Also I'm leaping to the assumption that D&D Next will eventually have an interesting and robust system of diseases and poisons, as 4e did.) So here are some additional options:

Skill Check DC Benefit
10+Wounds Treat Wound: If this skill check is higher than the target's Constitution saving throw to remove a Wound, use this skill check value instead.
15 Bolster Recuperation: When spending HD to recover hit points, the target rolls an additional die of the same type and drops the lowest value. This stacks with the Durable feat.
15 Bloodletting for Disease: The target spends a Hit Die and adds that value to a new Constitution saving throw against the disease currently affecting her. If successful, reduce the severity of the disease by one step. (+5 skill check DC for uncommon disease, +10 skill check DC for rare disease)
20 Bloodletting for Poison: The target spends a Hit Die and adds that value to a new Constitution saving throw against the poison currently affecting him. If successful, the poison is neutralized. (+5 skill check DC for uncommon poison, +10 skill check DC for rare poison)
25 Extraordinary Recuperation: When spending HD to recover hit points, the target rolls an additional die one step smaller than the HD being spent and adds that value to the amount recovered. This stacks with the Durable feat, but not with Bolster Recuperation.

This adds a bit more complication and dice manipulation to the healing process, but I think it also gives players much stronger reasons to want to train the Administer First Aid skill, and possibly invest feats in improving that skill. (Unlikely, but possible.) Also, it touches briefly on humorial medicine, which as every Dust to Dust player knows is something I adore. Yay, leeches! I think it's good to have both a Moderate and a Very Hard DC for natural healing, so that players can hope for something along the lines of a critical success.

It wouldn't be too difficult to store all of the Administer First Aid options on the back page of the character sheets my group uses. As with all skill uses that are player-initiated, the player needs a good idea of the range of possibilities.

A Little More About Why I Did It This Way

The system around Wounds may slow down play a bit, as opposed to an "always-active" problem that inconveniences the character. D&D Next has an unusual approach to granularity, though, that becomes evident when talking about small bennies or small hindrances. The designers have largely avoided small situational bonuses and flat adds, in part because of bounded accuracy and in part because 4e showed us that the game grinds to a halt when a player has to remember and parse half a dozen if-then statements in order to make a roll. The general tenor of the design works more along the lines of rolling more dice and adding or subtracting their values from other things (solving the bounded accuracy problem) without creating all that many ways to stack up benefits or hindrances. For example, Advantage and Disadvantage are almost all that is possible for modifying attack rolls. (I still think they need another grade of benefit and hindrance, but WotC obviously disagrees.)

To that end, I want Wounds to be something that could pile up on a character. My hope is that risk increases fairly slowly and mostly remains manageable, so that characters feel like they can and should keep adventuring (if they're on a timeline) rather than absolutely having to call it a day. It adds one roll to the damage-resolution stage, in a way that embraces fighter-types being tougher than other classes. (Multiclass characters, once those rules come out, would use the HD that they have in the largest number, defaulting toward the larger die if the character is evenly split.)

It's definitely possible that I've made this too good or not good enough. As the WotC devs are fond of saying, tweaking the math is the easy part. Do these ideas work on a basic level, even if I need to modify the math?

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