D&D House rules for 0HP, injury and death

Draft: consider the below a draft, I may make changes after more game testing or feedback.

In Dungeons & Dragons (5e) the sensible way to understand HP damage is as scratches, concussion and exhaustion. It is all healed after a long rest. However if you reach 0HP you fall unconsious, and then you will live or die within 3-5 turns (30 seconds).

First I want to say that I appreciate D&D and its simple and forgiving approach to damage. I also appreciate that 0HP does not mean immediate death. That said, I think there could be a little more going on between 1HP (fully fighting) and 0HP (high risk to die in 3-5 rounds).

These house rules make use of

  • Hit Dice (PHB p186)
  • Death Saving Throws (PHB p197)
    (but modify roll with CON, and other effects than 3+3 check boxes)
  • Lingering Injuries (DMG p272)
  • Exhaustion (PHB p291)
  • Negative Hit Points (not in the standard rules) means character is unconscious.

When a character reaches 0 HP she becomes unconscious and unstable. That activates the house rules.

Death Saving Throws

Death Saving Throws are made until the character is conscious (although they just decide recovery rate for a stable character). Roll d20+CON. Success is 10 or higher.

While the character has Hit Dice available, spend one Hit Dice and roll a Death Saving Throw every round. On success, recover HP for the Hit Dice as if spent during a short rest.

While the character has no Hit Dice, roll a Death Saving Throw after every minute (or 1d12+5 rounds). On failure, get one Exhaustion. On success recover one HP. If the modified result was at least 20, recover one more HP. A natural 1 gives two Exhaustion and a natural 20 gives one more HP (a total 3 HP is possible on a natural 20).


A character is stabilized:

  • When standing at at least 1HP
  • When treated with Wisdom (Medicine) DC 10 for a minute
  • By any magic healing effect

Recovering Consciousness

A stable Character recovers consciousness when she reaches 1HP. While unconscious, roll Death Saving Throws every round/minute as above, but receive no Exhaustion on failure.

A character that recovers from such unconsciousness is incapacitated for the next round and has disadvantage on everything until after a short rest.

For practical purposes, a stable unconscious character with zero Hit Dice can after the equivalent of a short rest have 1d4 HP and no disadvantage.

If taking further damage while unconscious and stable character is again unstable.

Risking Lingering Injury

When a character is reduced to 0 or less HP, she has the option to immediately

  • spend one Hit Dice, and
  • remaining conscious (not incapacitated and no disadvantage) if at least 1 HP, and
  • roll once on the Lingering Injury table.

This can be seen as a bold final move that the fighting character makes to stay in battle even if it means injury.

Harsch conditions

Falling unconscious, being abandoned in bad conditions (a desert or the winter), perhaps lacking food, water and opportunity to rest and care for the wounds can obviously jeoperdize survival and recovery, at DMs discretion.


The reason and logic behind these D&D house rules is that in reality, creatures who suffer trauma and become unconsious rarely die within 30 seconds (5 rounds). It is also hard to imagine an ally doing first aid within 30 seconds. The original rules of D&D 5e are very beneficial to large groups of characters with magical healers among them (esp Healing Word, which immediately heals at a distance). However, they make it very dangerous for a member of a smaller group without healers to become unconcious.

So, these rules make it less deadly to reach 0HP. But it also hurts more to become unconsious and you are not back on your feet fighting in a few rounds.

Ultimately D&D is not about killing the player characters, but about story telling and adventures. These rules are there to replace death with something more interesting, without making damage, injury or death much less scary.


As is mentioned in the core rules, most enemies simply die at 0HP. These rules can be used for important NPCs and player characters.

On D&D

D&D is a simple and fast game. I don’t want to intruduce rules that feel like they rather belong in another game. Everything should be made as simple as possible but not simpler. I have tried to make it simple but perhaps I can do better.

These rules are not to be used very often. But when the characters of my players are a little spread out, and one of them reaches -1 HP, I just don’t want her to die.

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