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).

Stabilizing

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.

Background

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.

On NPCs

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.

Imagine an ancient magic wild sparsely populated D&D world with no civilizations. Plant some seeds of familiar cultures like egyptians, vikings, saxons, babylonians as well as elvish, dwarvish. Imagine these cultures grow in your D&D soil, easily bringing rich and familiar civilizations to your D&D world.

Background

When playing D&D you need some kind of world. If you purchase adventures that already take place in a published world then so is it.

But if you craft your own campaign you also need to pick or craft a world. I see three obvious options:

1. You pick an existing world (like Forgotten Realms or Dark Sun)
2. You create your own world (top down)
3. You start very small, a town and a dungeon, and build from there

I think, as DM I like to have things connected and on a foundation, but the players dont care about that. However, the players have expectations, and as a DM I it is my challange to surprise them without disappointing or confusing them (to meet and exceed their expectations).

I think DM and players can agree that there should be a simple description of the world that everyone can understand and agree on.

What comes with D&D

D&D actually comes with a world. It has no name or map, but it is an untamed ancient magical world, overseen by gods, of good vs evil, with monsters and medieval technology (DMG 5e, page 9). It does not have to be, but if your world is different you should probably tell your players first (or find another rules system).

It is not the Earth, it is not the Earth plus mythology, it is not Hyboria (the world of Conan, on Earth), and it is not Middle Earth (of Tolkien), or any other world. But it borrows from all these, and other worlds. I love this world!

There are references to Druids, The Great Old One, Samurais (in Xanathars Guide to Everything), Hell (nine of them), Mithral (why not Mithril?) and so on.

When it comes to monsters there are those with very specific origin like Kraken, Minataurs, Mumies, Unicorns and Yeti, but also original D&D creations like Beholders and Rust Monsters (I am not an expert).

Xanathars guide to Everything contains almost 20 pages just listing names from different cultures, mostly from Earth. PHB contains listings of Gods of several pantheons from Earth.

So from the beginning, D&D comes with hooks to many different earth cultures and fictional worlds. Just as every fictional world, every fantasy novel or movie, and any board game or computer game.

The name of an NPC matters: Okkuch, Sintraniel or Grolf makes a difference. What if I give them family names like MacWaldin, von Snorrhauff or Angurelius? It matters, for many different obvious reasons. And NPC#32 does not work.

What I ask myself as a DM all the time is: what can I pull into my campaign from things I and my players know to make it more colorful and easy to understand to my players, and not confuse or disappoint them?

Actually, what can I pull from the core rules, and my players accept it? The local criminals are lead by a Beholder? A Flumph anywhere? Truly good dragons? The kings men are all Eldritch knights? A Portal to Hell? Feywild and Shadowfell? Half-orcs being citizens? Dragonborns and Tieflings?

Everyone has an image of the D&D world they play in in their head. It is not a clean slate. It is a mess. And it is personal.

And then I started thinking about culture…

Using existing cultures

I am not talking about a real historical setting, not about a magical variant (like Ars Magica), not about a commonly known fictional world (like Hyboria, Middle earth, or the world of Game of Thrones): I am just talking about cultures that I and my players know something about.

The Ancient Greek culture. The idea of it immediately gives estetics, architecture, weapons, clothes, traditions, values and ideas, politics, government, a pantheon (already in PHB), monsters (already in Monsters Manual) and how things are named. The same is true for many more cultures (on earth, or fictional if you want, although ancient Greece may be particularly influential and well known).

It is common in movies, litterature and computer games to use existing cultures quite liberally. It is not that common to invent a new world (and when done, it is usually very inspired by earth).

I can kind of understand that huge ambitious projects like the commercially available D&D worlds name their own cultures. But it makes Forgotten Realms very confusing – hard to learn and use – to me.

Planting culture seeds in D&D soil

Imagine a D&D world; ancient, magical, untamed, wild, sparsely populated and brutal. Place a seed of a known civilization there, like ancient Greece (in this particular case it is quite plausible, because there are known gods that may have guided people). Let some time pass. Imagine the result.

Think “the computer game Civilization, on a D&D planet”. Multiple civilizations, as well as fantasy cultures of elves, gnomes, dwarves and others. You can of course add your own cultures.

I don’t see any need to detail a big world, describe its history, all the cultures/civilizations and their relationships. I just feel that this is a very simple story that anyone can understand. And it works for quite colorful storytelling. You can at any moment introduce a samurai, a crusader, raiding vikings, or spartan warriors just like that. This works for movies and computer games, it should work for D&D too.

The god is Zeus, the monster is a Minataur, the capital is Athens, the temples are of marble and they like debate and wine. Zeus and the Minataur are already in the core rule books. Zeus is a god, who can look after your world too, and to the people worshipping Zeus it is natural to call their capital Athens. Their lore is superior to anything in Forgotten Realm: rich, colorful, original, consistent, accessible, well known.

Would your players accept it? Why not?

A Map

I don’t see any point in mapping the entire world or picking all civilistions. Just keep track of what you have introduced (as in a game of Civilization). Beyond the war of fog can be anything.

I imagine you can use the map of the earth if you like, or not.

Duck Test Argument

If it looks like a duck, walks like a duck and quacks like a duck, it is probably a duck. Nobody would believe that the Common language in D&D is the same as English (or any other language on Earth). Isay: if it looks like a viking, it fights like a viking, and it smells like a viking, it is probably a viking.

Simplicity Argument

Einstein said Everything should be made as simple as possible, but not simpler. My point is that you as a DM and your players have limited time and resources to put into your D&D game. It is probably a waste of time to put effort into making up cultures that nobody easily can relate to, when in fact you are anyway mostly making poor confusing inconsistent shadow copies of amazing original cultures.

Original Lore

It really makes more sense to me to read about ancient Greece, Babylon, the Vikings or ancient Egypt – gaining real knowledge useful outside D&D – rather than trying to make sense of the mess of Forgotten Realms (and someone just telling me that Icewind Dale is “like the vikings of Forgotten Realms”).

Draw the Line

Obviously every fantasy culture is more (often) or less (rarely) inspired by cultures on earth. This is one of my points: if we want a viking culture why not just call it viking (we are anyway borrowing weapons, naming people and places, using estetics, architecture, customs and so on.

My idea is that what should be left on earth is

• Historical people
• Historical events, especially between cultures

What you need to adapt or think about is

• Relationships to other cultures, conflicts
• Technology (since it is a D&D world and this culture exists side by side with other earlier or later cultures)
• Magic

What you can use, right away, to avoid confusion and make everthing clear

• Names of places
• Hope people are named
• Architecture
• Weapons
• Clothing
• Art
• Customs
• Ethics
• Politics
• Values

If you want to change many of those things, maybe you should invent your own culture!