It’s pretty easy to lose an eye, hand, or organ… in D&D! Let’s talk about lingering injuries. The fifth edition Dungeons and Dragons Dungeon Master’s Guide provides a handy new optional rule for combat with consequences beyond draining hit points and hit dice. Lingering injuries make it so a player character can suffer a more debilitating injury (like losing a body part or internal organ damage) after suffering a critical hit, falling to 0 hit points, and/or failing a death saving throw by 5 or more. These injuries come with a mechanical penalty which makes sense when paired with the flavor of the wound.
Some folks out there, like my main man David Gibson of 5-Minute Workday, have taken issue with lingering injuries as presented in the Dungeon Master’s Guide. They feel the chances of losing an eye or a limb are too great for most games. What if someone wants to play with lingering injuries, but does want to have to cast the regenerate spell every session? Ya know, gritty lite instead of straight up gritty.
Perhaps there are others of you who would like to see more opportunities for PCs to suffer lingering injuries. You might feel like combat is hazardous to the PCs’ health and the rules should reflect that. You’re looking for whole grit in your campaign. None of the 2% stuff.
Well in today’s post I’m going to address these issues by presenting a variant rules which affect how often lingering injuries occur plus a bunch of new lingering injuries to add to your game. Get excited people! It’s time to hurt some PCs.
Lingering Injuries Variant Rules
Here are some variant rules you can add to the Lingering Injuries module presented on pages 272 and 273 of the Dungeon Master’s Guide.
Variant Rule: You Fireballed My Leg Off
In addition to the options already presented in the Dungeon Master’s Guide, a creature may sustain a lingering injury after rolling a natural 1 on a saving throw against a spell, magical, or trap effect that deals damage to the creature.
Variant Rule: Lose an Eye, I Choose You
When you score a critical hit by attacking a paralyzed or unconscious creature within 5 feet of you, you can choose the lingering injury which effects the creature as a result of the critical hit instead of rolling on the Lingering Injuries table.
Variant Rule: Confirm Lingering Injury
When you suffer an effect that would cause you to roll for a lingering injury, first roll a d20. If you roll a 1-9, roll on the Lingering Injuries table as normal. If you roll a 10-20, the effect does not cause you to suffer a lingering injury. This variant rule is meant to reduce the number of lingering injuries which occur at the table.
Variant Table: Expanded Lingering Injury
The table below is meant to expand the injury options from the ones presented in the Dungeon Master’s Guide. Whenever you would roll on the Lingering Injuries table, you can choose to roll on the Expanded Lingering Injuries table instead.
Expanded Lingering Injuries
| d100 | Injury |
| 1-2 | Lose an Eye. You have disadvantage on Wisdom (Perception) checks that rely on sight and on ranged attack rolls. Magic such as the regenerate spell can restore the lost eye. If you have no eyes left after sustaining this injury, you’re blinded. |
| 3-4 | Lose an Arm or a Hand. You can no longer hold anything with two hands, and you can hold only a single object at a time. Magic such as the regenerate spell can restore the lost appendage. |
| 5-6 | Lose a Foot or Leg. Your walking speed is halved and you must use a cane or crutch to move unless you have a peg leg or other prosthesis. You fall prone after using the Dash action. You have disadvantage on Dexterity checks made to balance. Magic such as the regenerate spell can restore the lost appendage. |
| 7-8 | Lose an Ear. You have disadvantage on Charisma (Persuasion) checks and Wisdom (Perception) checks that rely on hearing. You have advantage on Charisma (Intimidation) checks. Magic such as the regenerate spell can restore the lost ear. |
| 9-10 | Lose Nose. You have disadvantage on Charisma (Persuasion) checks and Wisdom (Perception) checks that rely on smell. You have advantage on Charisma (Intimidation) checks. Magic such as the regenerate spell can restore the lost nose. |
| 11-15 | Blurred Vision. You have disadvantage on Wisdom (Perception) checks that rely on sight and on ranged attack rolls. The injury heals if you receive magical healing. Alternatively, the injury heals after you spend three days doing nothing but resting. |
| 16-20 | Broken Arm or Hand. You can no longer hold anything with two hands, and you can hold only a single object at a time. The injury heals if you receive magical healing. Alternatively, the injury heals after someone sets the bone with a DC 15 Wisdom (Medicine) check and you spend thirty days doing nothing but resting. |
| 21-25 | Broken Foot or Leg. Your walking speed is halved and you must use a cane or crutch to move. You fall prone after using the Dash action. You have disadvantage on Dexterity checks made to balance. The injury heals if you receive magical healing. Alternatively, the injury heals after someone sets the bone with a DC 15 Wisdom (Medicine) check and you spend thirty days doing nothing but resting. |
| 26-30 | Ringing Ears. You have disadvantage on Wisdom (Perception) checks that rely on hearing. The injury heals if you receive magical healing. Alternatively, the injury heals after you spend three days doing nothing but resting. |
| 31-35 | Limp. Your walking speed is reduced by 5 feet. You must make a DC 10 Dexterity saving throw after using the Dash action. If you fail the save, you fall prone. Magical healing removes the limp. |
| 36-40 | Lose a Finger. You have disadvantage on Dexterity (Sleight of Hand) checks and Dexterity checks to use fine tools (such as thieves’ tools) using the hand with which you lost the finger. Magic such as the regenerate spell can restore the lost finger. If you lose all the fingers from one hand, then it functions as if you had lost a hand. |
| 41-45 | Break a Finger. You have disadvantage on Dexterity (Sleight of Hand) checks and Dexterity checks to use fine tools (such as thieves’ tools) using the hand with the broken finger. The injury heals if you receive magical healing. Alternatively, the injury heals after someone sets the finger with a DC 10 Wisdom (Medicine) check and you spend ten days doing nothing but resting. |
| 46-50 | Break an Item. A randomly determined nonmagical item you hold, wear, or carry on your person is broken or ruined. Roll a d10. On a roll of 1, the item broken is a weapon, on a roll of 2 the item is armor or a shield, and on a roll of 3-10 it is an item that’s not a shield or weapon. |
| 51-55 | Teeth Knocked Out. You have disadvantage on Charisma (Persuasion) checks. When you cast a spell with a verbal component there is a 25% chance the spell will not work. If the spell fails, you still used your action to try to cast it, but the spell did not use any slots or material components. The injury heals if you receive magical healing. |
| 56-60 | Festering Wound. Your hit point maximum is reduced by 1 every 24 hours the wound persists. If your hit point maximum drops to 0, you die. The injury heals if you receive magical healing. Alternatively, someone can tend to the wound and make a DC 15 Wisdom (Medicine) check once every 24 hours. After ten success, the injury heals. |
| 61-65 | Open Wound. You lose 1 hit point every hour the wound persists. The injury heals if you receive magical healing. Alternatively, someone can tend to the wound and make a DC 15 Wisdom (Medicine) check once every hour. After ten success, the injury heals. |
| 66-70 | Skull Fracture. Whenever you attempt an action in combat, you must make a DC 20 Constitution saving throw. On a failed save, you lose your action and can’t use reactions until the start of your next turn. The injury heals if you receive magical healing or if you spend thirty days doing nothing but resting. |
| 71-75 | Punctured Lung. You can take either an action or a bonus action or your turn, but not both. The injury heals if you receive magical healing. If you puncture both lungs your hit points drop to 0 and you immediately begin dying. |
| 76-80 | Internal Injury. Whenever you attempt an action in combat, you must make a DC 15 Constitution saving throw. On a failed save, you lose your action and can’t use reactions until the start of your next turn. The injury heals if you receive magical healing or if you spend ten days doing nothing but resting. |
| 81-85 | Broken Ribs. This has the same effect as Internal Injury above, except that the save DC is 10. |
| 86-90 | Horrible Scar. You have disadvantage on Charisma (Persuasion) checks and advantage on Charisma (Intimidation) checks. Magical healing of 6th level or higher, such as heal and regenerate, removes the injury. |
| 91-95 | Painful Scar. You have a scar which gets painful whenever it rains, sleets, hails, or snows. Whenever you attempt an action in combat and your scar is giving you pain, you must make a DC 15 Constitution saving throw. On a failed save, you lose your action and can’t use reactions until the start of your next turn. The injury heals if you receive magical healing. |
| 96-100 | Minor Scar. The scar doesn’t have any adverse effect, but chicks dig it. Magical healing of 6th level or higher, such as heal and regenerate, removes the scar. |
If you like these variant rules for lingering injuries and want them to have and hold forever, go ahead and grab them in the PDF below.
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World Builder Blog 
First off, I love that you referenced a Cranberries lyric in the title of this article.
Secondly, what about the option of letting a player who is hit by a crit choose whether a critical hit does extra damage (doubling dice as normal) or inflicts a lingering injury on the character? That’d give a slight tactical choice, giving them a bit of control for how this negative story element in the combat affects their character. Plus then the DM is absolved of all later complaining about the effects of the lingering injury. “You didn’t HAVE to lose an eye, Jim, you COULD have taken an extra 5d6 damage instead.” I think this’d promote more dramatic fight scenes, esp if the big villain takes a dramatic lingering injury from the hero before making a tactical retreat.
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As always, Joe, that’s a great idea. I should really make a variant rule using that….
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Nice. This is some good stuff – I really like it when there are lingering wounds. It adds character to characters (pun intended). I had an AD&D Paladin with hideous burn scars and a missing eye by the time he was 21 (ancient indeed in AD&D terms). Good times. 🙂
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Now that sounds like a fun game. Glad he lived to see 21!
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Hehe, yeah it was glorious. No doubt the best game ever. The terror of AD&D cannot be overestimated. Doing 1d10+2 was big damage…and those monsters had CLAWS. 🙂
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I am currently having the characters and monsters roll a DC 15 con save if they lose half or more of their HP to a single effect. If they fail I have made a modified table which includes madness.
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Nice! If you can share that table, I’d love to see it. Badass!
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Loving most of it and might steal it with one exception. All the ones that take 30 days to heal can be bypassed with magical healing of a 1s level spell or higher. This makes them a toutch harder and while any level character can heal it it uses up a precious resource since clerics do have a can trip to heal an lay on hands would only need to expend 1hp to fix it, but that’s my 2 cents. Jew reader and loving everything so far.
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Clerics have a cantrip that can heal? Good point about the lay on hands.
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yes clerics have a lvl 0 healing spell which heals 1 hp. Its called “Cure Minor Wounds”
to get around this, you could have it that the healing magic has to equal the damage done to remove the effect. For instance if a skull fracture was rolled after a critical hit that dealt 9 dmg, the healing magic would have to heal 9 dmg to remove the effect, this could be with 1 spell or multiple.
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Good fix, though these particular rules are for 5e which does not have that spell.
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I’m working on a modified set of rules for lingering injuries in 5e and your expanded chart is very helpful. The nine wounds listed in the DMG are far too minimal and would become repetitive quickly. My modification changes how the wounds are removed, and I’d appreciate any feedback you could give.
In short, I’m using the lingering wounds system to overcome how easily my six-player party deals with hitting 0 hit points. Since there is always two to three healers in the group and my campaigns are not combat focused, my players almost always have the resources to revive a downed player within the same round they dropped.
I want to introduce lingering wounds whenever players hit 0 to add more tension and danger to combat, but I don’t want any of these wounds to be permanent. I don’t feel crippling a player with a lost limb or eye adds any fun to the game when there’s no reasonable way to remove it at low levels. On the other hand, most of the wounds are removable with any magical healing, which translates to spending an extra level one healing spell after the player is revived. After level five that’s a rather minimal penalty in a large party such as ours.
My solution is to add a scaling numeric value to the healing required to remove the injury. For example, a tier one injury requires any magical healing to fix, but a tier two requires 10 points of healing, and a tier three requires 15, ect. The scaling should be adjusted by the DM as players level so the worst wounds require a good roll on the highest level Cure Wounds they can cast, or multiple casts of lower level heals. Additionally, healing done to remove wounds is not added to the player’s hit points.
I realize calculating the scaling value for the wound healing adds a decent amount of bookkeeping to the DM, but it’s the best solution I’ve come up with for keeping the resource cost of healing wounds relevant throughout the campaign. The only other idea I have is make the healing costs static, and if players need to stop adventuring to heal a really bad wound, so be it. While less work for the DM, I doubt any player group would find anything fun in being forced to drop whatever they are doing for a couple of days while the healers reattach a limb.
I’m wrestling with the balance between fun, tension, and realism. I don’t want my players to disregard being knocked to 0, but I don’t want them to advance at a snail’s pace through dangerous locations for fear of running out of healing. After running the last campaign that lasted nearly a year, I’m certain the base rules are too forgiving. Do you think this concept could work to fix it, in conjunction with your expanded table?
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Licata, this is an interesting idea and sounds right for your game. You might want to adjust to make it healing spells of a certain spell level instead of number of HP. Spending a 9th level spell slot to regain an eye is a big deal when it could have been spent on Meteor Swarm or Foresight. Remember that REGENERATE is a 7th level spell that restores HP and lost body parts, so you may have to house rule that in your game as well.
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Thanks for the reply. I was intending to let regenerate heal all wounds, and was only basing the scaling on the Cure Wound spell. There’s other high level heal spells that do more than Cure Wound by a large margin, so I don’t think players will ever have to spend 8th or 9th level spells.
Do you have an opinion between static and scaling costs? In other words, do I set the cost and roll the dice (creating a small chance for players taking big wounds that only a day of rest so the healers can cast all their slots into it) or do I scale it so a single wound wouldn’t end an adventuring day?
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It really depends on what you want for your game. Sounds like you’re trying to balance realism with fun. If you don’t have that much combat, I’d say it’s ok to lean hard into dire consequences.
You could say “It takes 30 HP to restore this wound” and have that be 30 HP restored in any combination of spells over any amount of time, or you could say, “It takes 30 HP in one casting of a spell to restore this wound” so they might waste several spells on to get there.
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I finished my revised lingering injury table, and I’m pleased with out it turned out. It now has almost 30 wounds keyed to a d100 and divided up into five tiers. The tiers are there to help me calculate the scaling healing threshold more easily.
Since this table is heavily based on your work, I feel it’s only fair to post a link here. Please feel free to use it in any way you wish. Thanks for your help.
https://docs.google.com/spreadsheets/d/1PxtI79vntIsaDmQpyRPhwbbR_Y8uOeNDeCq50pKmZpY/edit?usp=sharing
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Hey thanks for sharing!!!! This is really cool. Nice work!
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