Knocking on Death’s Door: Alternative Rules for Lingering Injuries & Losing Consciousness in D&D 5E

Ever noticed how tough battles in D&D tend to turn into a game of whack-a-mole? One hero reaches 0 HP and falls over. One of their friends runs over and casts cure wounds or force-feeds them a potion and they’re back up again. A round or two later, someone else drops and the cycle repeats.

I think the main reason for this is the sudden transition from up and fighting to comatose and bleeding out on the floor. True, the players can see their HP dropping, so they know they’re getting closer to death, but there’s no mechanic that really drives that home, that says, “Hey, buddy—maybe it’s time to cut your losses and retreat.” Without that nudge, players tend to keep fighting until they drop, and at that point there’s nothing they can do but wait for someone to tag them back in.

To address this issue, I’ve added a house rule to my D&D games. It gets the job done, and my players enjoy it, too. But before I explain how it works, let me give credit where credit’s due. I modeled this idea off of a post by the Angry GM. I tweaked it to suit my taste, but he’s the one who came up with the basic concept.

It involves adding a new condition called “dispirited.” A PC becomes dispirited when they reach 0 HP. When the PC becomes dispirited, they gain 1 level of exhaustion. As soon as they have at least 1 HP, they’re no longer dispirited.

The effects of being dispirited are:

  • You can’t attack or cast spells.
  • If you’re damaged again, you suffer a lingering injury. Also, you must make a Constitution saving throw. If the result is lower than 10 or the amount of damage you just took (whichever is higher), you become unconscious and unstable.

The idea here is to encourage the PC to pull back by cutting off their ability to contribute to the battle while adding the threat of real, long-term consequences. It also has the benefit of giving players something to do when they reach 0 HP and giving the GM a fair mechanic for introducing lingering injuries, which make the battles feel more brutal and realistic.

Speaking of lingering injuries, I find the table in the Dungeon Master’s Guide too complex for my taste. Here’s my own trimmed down version:

Lingering Injury. If you take damage while at 0 HP or if the damage is of an especially serious nature, you gain a lingering injury. The GM can choose something from the table below or have you roll 1d20. Only magical healing of 6th level or higher removes a lingering injury.

  • (1-5) Permanent Scar. A nice conversation starter.
  • (6-8) Impaired Arm. Disadvantage on any action that requires the injured arm, such as attacking, climbing, grappling, or swimming. Heals after a 10-day rest.
  • (9-11) Limp. Total movement speed reduced by 5. Disadvantage on climbing, jumping, etc. Heals after a 10-day rest.
  • (12-13) Internal Wound. You must succeed on a DC 10 Constitution save in order to take any combat action or reaction. Heals after a 10-day rest.
  • (14-15) Festering Wound. Your maximum HP drops by 1 each day. If you reach 0 max HP, you die. Heals after you have been successfully treated five times (DC 15 Medicine check once per day).
  • (16-17) Disfigured. Disadvantage on Persuasion. Advantage on Intimidation.
  • (18) Ruined/Lost Leg. Your total movement speed is halved. Disadvantage on climbing, jumping, etc.
  • (19) Ruined/Lost Arm. You can’t use your left or right hand. Disadvantage on climbing, grappling, swimming, etc.
  • (20) Lost Eye. Disadvantage on Perception. If you have already lost an eye, you become blind.

The Complete Idiot’s Guide to D&D 5E

Let’s face it. D&D’s a great game, but it can get a bit overly complicated at times. I know not everyone agrees, but I like my game sessions to be fast-paced and relatively simple. And, as a GM, I prefer to spend as little of my prep time as possible flipping through rulebooks. If you feel the same way I do, this rant is for you. Here are all the cuts and edits I’ve made to D&D’s core rules in order to keep my gaming nights moving and the headaches at a minimum.


Ah, combat. The focal point of D&D’s mechanics and yet arguably the part of the game that needs the most work. Where to begin?

Special Attacks. I think there are several separate mechanics here that can be combined. You can replace a normal attack action with any of the following actions.

  • Disarm. Make your attack roll, but instead of rolling against the opponent’s armor class, the opponent sets the DC with an Acrobatics or Athletics roll. If the opponent is wielding a two-handed weapon, make your attack roll with disadvantage.
    • Note: One of my house rules is that a creature gains advantage on an Athletics roll when facing off against a smaller opponent. And if the creature is larger by 2 sizes or more, the larger creature wins the contest automatically.
  • Grapple, Throw, or Trip. To attempt any of these moves, roll Acrobatics or Athletics (your choice). The opponent resists by rolling Acrobatics or Athletics as well (their choice). If you throw a creature, you can move it up to 5 feet away and deal 1d4 damage.
  • Overrun or Shove. If you want to force your way past an enemy creature or push it to an adjacent space, make a contested Athletics roll with it.

Climb a Creature. As an action, you can climb on top of a creature larger than you. Make a contested Acrobatics roll with the creature.

Dash. As an action, you can double your total movement for the turn. You gain a point of exhaustion if you dash for a number of consecutive turns equal to 3 + your Constitution modifier.

Search. This isn’t specified as an action in D&D, but in my opinion it should be. As an action, you can make a Perception roll to check the area around you for hidden creatures and objects. The DC for detecting a hidden creature is 10 + its Stealth bonus.

Opportunity Attack. When a creature within reach of your weapon moves out of your reach or takes a non-combat action, you can use your reaction to make an immediate attack against them, even if it’s not your turn. Only one adjacent creature can make an opportunity attack for each space the target creature moves through (otherwise you get into ridiculous situations where 7 enemies stab you all at the same time as soon as you take a step in the wrong direction). You can’t make an opportunity attack if you used the Dash action on your last turn.

Mobs. For something that comes up all the time, D&D has a really convoluted way of handling a violent mob trying to attack the same target at once. I think it’s fair to say simply that, when a large group of creatures gang up on a single target, the DM can forego making attack rolls to save time and just assume that they get 1 hit in for every 3 attackers or so. This also serves to make large groups of enemies more threatening to the PCs. If you play by the rules as written, you may find that a PC with heavy armor can essentially wade through a sea of smaller enemies without getting scratched.

Cover. In D&D 5E, they came up with this brilliant advantage/disadvantage mechanic so the players wouldn’t have to keep track of a whole bunch of circumstantial plus and minus modifiers to rolls. But for some reason they decided hiding behind cover in combat needed its own special mechanic. Bollocks, I say! If you have cover, attacks against you have disadvantage.

Underwater Combat. This one doesn’t come up too often, but D&D has some overly complex rules here, too. The following simplified mechanics should work just fine.

  • Bludgeoning and Slashing Attacks. Unless you have a swim speed, you attack with disadvantage when using a bludgeoning or slashing weapon underwater.
  • Ranged Attacks. All ranged attacks have disadvantage at normal range and miss automatically at long range.
  • Fire Attacks. All creatures have resistance to fire damage while underwater.


Counting spaces during a battle isn’t usually so bad, but there can be a lot to keep track of once you start getting into nitty-gritty stuff, like difficult terrain. The following rules are based on the actual D&D mechanics, but with some of the details removed to make them easier to remember and apply during play.

Slow Move. Each time you move 1 space (5 feet), count 1 extra space from your movement total if any of these factors apply: climbing, crawling, difficult terrain, or moving through an occupied or tight space.

Half Move. It costs half of your movement total to do any of the following: dismount an animal, mount an animal, stand up.

Encumbrance. If you’re pushing or pulling something heavier or larger than what you can normally carry, your total speed is reduced to 1 space (5 feet) per turn and you have disadvantage on all rolls you make.

Jump. Roll Acrobatics or Athletics. For a long jump, the result of the roll is equal to the number of feet you can cover (a roll of 15 means you can jump a distance of 15 feet). For a high jump, divide the result by 3 (a roll of 15 means you can jump up to 5 feet). If you can’t get a running start, roll with disadvantage.

Tumble. If you want to dodge around an enemy creature blocking your path, you can use a bonus action (not a normal action), to make a contested Acrobatics roll with the creature. You don’t need to roll if the creature is larger than you by 2 sizes or more (i.e., if you’re medium and it’s huge).


Is it just me, or are the D&D conditions largely redundant? After some tinkering, I managed to smush the similar ones together to make for a more streamlined, easier to remember list. (The conditions that I didn’t change aren’t included here.)

Disadvantaged (Frightened, Poisoned)

  • You have disadvantage on attacks and ability rolls.
  • If you’re frightened, you can’t approach the object of your fear or take any offensive action against it.

Hindered (Grappled, Prone, Restrained)

  • You have disadvantage on attacks and Dexterity saves.
  • Melee attacks against you have advantage.
  • Ranged attacks against you have disadvantage.
  • If grappled or restrained, your speed is reduced to 0. You can roll Acrobatics or Athletics to escape.

Immobilized (Incapacitated, Paralyzed, Petrified, Stunned, Unconscious)

  • You can’t move, speak, or take actions of any kind.
  • Attacks against you automatically hit.
  • You automatically fail all saving throws.
  • If you’re petrified, you have resistance to all damage and any poison or disease in your system stops affecting you (it starts affecting you again as soon as you stop being petrified).


The rules for how much exhaustion you gain due to lack of water, sleep, and food are convoluted and make little sense. Here’s a simpler system, which is also closer to the real-world effects of dehydration, sleep deprivation, and starvation:

  • Gain 1 level of exhaustion after 1 day with no water.
  • Gain 1 level of exhaustion after 2 days with no sleep.
  • Gain 1 level of exhaustion after 3 days with no food.

Exhaustion gained in this way does not “stack.” For example, if you’re already gaining exhaustion due to lack of water, you can ignore any exhaustion you would gain from lack of sleep or food.

A Critical Look at Critical Fumbles in D&D 5E

Most players of D&D are familiar with this little optional rule—when a character rolls a 1 on an attack roll, they not only whiff but hit themselves in the face or send their weapon flying out of their hands, or any number of other harmful or at least embarrassing screw-ups. Of course, it’s not terribly realistic. While someone who’s never held a sword before may do more damage to themselves than the enemy, the majority of people who make attack rolls in D&D are trained—if not expert—fighters. A battle-worn champion shouldn’t be flailing wildly with every twentieth swing.

So if you prefer to run serious, dramatic, and realistic scenes, you’re probably better off doing without critical fumbles. But I’ve always preferred to keep my games on the silly side. There’s nothing like a hero accidentally conking an ally over the head at the worst possible time, or a villain delivering a menacing monologue and then immediately tripping over their own feet. Some of the most memorable moments from my games have come from critical fumbles.

The problem is in finding a quick and dirty way to resolve these moments when they do pop up. Combat in D&D is already a bit clunky and stilted under the best of circumstances—the last thing it needs is another complicated series of tables to slow things down.


Yeah, no thanks. I’m good.

Fumble Charts - Google Docs.png

Please stop…


Oh god why

As you can see, some people out there really like their critical fumbles. And if you’re one of them, hey, don’t let me stop you. But after considerable experimenting, the approach I’ve had the most success with is this little table of mine:

Critical Fumble! When you roll a 1 on an attack, roll 1d6.

  1. Distracted. Your turn ends. You can’t use a reaction until your next turn.
  2. Opening. One enemy may use a reaction to attack you now.
  3. Trip. Stumble 5 feet in a random direction or fall prone (GM’s choice).
  4. Self-Inflicted Wound. Roll your weapon damage. You take half that amount.
  5. Friendly Fire. Deal half your weapon’s damage to the creature closest to your original target.
  6. Disarmed. Your weapon (or something else you’re carrying) flies off in a random direction for 15 feet or until it hits a creature or obstacle. If it hits a creature, that creature takes 1d4 damage. If it hits an obstacle, the item becomes damaged or stuck (roll Athletics DC 10 to dislodge).
    • Ranged Attack Variation: If wielding a bow or crossbow, the drawstring breaks.

It may not look like much, but that list is robust enough to trigger some interesting situations without totally derailing the scene. It also works well because about half of the items on the list aren’t all that bad and seem like something even a skilled fighter might do from time to time (like getting distracted by something around them or swinging too wide and leaving an opening for the enemy to take advantage of). And, finally, it has the benefit of being short enough that you can memorize it pretty easily. After a few sessions, you won’t even need the table anymore.

Welp, that’s all I’ve got for today. Happy rolling!


4 Easy Ways to Amp Up Your Combat


Everyone who’s played RPGs (players and GMs alike) has been there: your characters are in the midst of what’s supposed to be a nail-biting melee—the climax of the adventure—but, for the players, it’s a dull routine of rolling dice and crunching numbers, interrupted only by debating strategy or flipping through rulebooks, until the last enemy falls over or retreats.

It’s a paradox. As far as the story is concerned, combat, by definition, is exciting—the characters are thrown into a life-or-death scenario and must rely on their strength and wits to survive. But the act of playing out the combat all too often fails to capture the tension in the story. As the stakes of the narrative rise, the time needed for calculating each action increases. A single swing of a sword could spell doom, so the story must be slowed down. In D&D, one round of combat represents six seconds of the characters’ lives, but it can easily eat up half an hour of the players’ lives if you’re not careful.

So here are four simple ways to make combat more exciting and fast-paced. I’ve tested them in my own games, and my players agree that our sessions are more fun because of them. Best of all, any GM can start using these right away, with little effort.

#1. Timed Turns

One of the quickest ways to slow a good game down is for the players to take too long to make up their damned minds. This is such a common problem that we have a catchy name for it: analysis paralysis.

So how do you stop the players from over-analyzing their actions? Simple: give them a deadline! I find a small sand timer (about 1 minute) works well, but an egg timer or smartphone app, or even a countdown should work in a pinch.

This is not just a technique for combat—you can use it whenever the characters have a limited time to act but the players start debating what to do. For example, I recently ran an adventure in which Thokk, the party’s half-orc barbarian, came across the camp of an orc tribe that had enslaved him as a child. Of course the party wanted to deliberate the most strategic plan of attack, so I placed my sand timer on the table and said, “When this runs out, Thokk loses his patience and charges into battle.” And before you complain that I was taking freedom away from the players, Thokk’s player agreed wholeheartedly with a grin.

Roll to See if You Cry.gif

#2. Roll ‘Em in Plain Sight

You might think that rolling behind a GM screen would be an effective way to keep tension high. After all, when a monster hits one of the PCs for 27 damage, they don’t know if the monster got lucky or if it’s just warming up. I argue, however, that hiding rolls takes away from the tension.

I used to play with a GM screen, but a year or so ago I decided to see how it felt without it, and I’ve never looked back. When you roll in front of your players, they share the thrill of watching the dice tumble on the table and spell their fate. It’s both empowering and frightening for them… empowering because the GM becomes just another player at the table, bound by the same rules they are; frightening because they know you’re not pulling any punches—if a monster rolls a 20 and kills someone in the party, them’s the breaks.


#3. Initiative Cards

In D&D (and most other RPGs I’m aware of), the GM and players make “initiative” rolls when combat starts to see who gets to go first. GMs typically handle this in one of two ways. The first is to roll for each individual combatant, record their rolls from highest to lowest, and proceed in that order. The GM may even require a fresh set of initiative rolls at the start of each new round. To save time, many GMs use a simpler method: make one roll for the good guys and another roll for the bad guys. When it’s the good guys’ turn, each player acts, usually in the order they’re sitting around the table. On the bad guys’ turn, the GM has each enemy act, in whatever order makes the most sense at the time. GMs using the second method typically make only one initiative roll at the beginning of the combat, and each side alternates turns from there.

Both methods have their flaws. The first method eats up a lot of time because it requires so many rolls and quite a bit of accounting. An organized GM can get through the process relatively quickly, but personally I find it immediately grinds the tension of the game to a halt when I have to make upwards of a dozen rolls right off the bat and write down each one. It also gives the game a kind of “classroom” feel, as the GM reads names off the list, telling each player when it’s their turn.

The second method saves time but lacks balance and variety. If the players go first, the combat might be over before the enemies get a chance to fire a shot, and vice versa. Moreover, on the bad guys’ turn, the players must wait for the GM to finish resolving each enemy’s action, and the GM gets no break in between deciding what each enemy does. This often turns into a headache for the GM and a snore for the players.

The way I solve this requires a deviation from the rules of the game, but I find the sacrifice is well worth it. At the start of each round of combat, take a red playing card for each PC and a black card for each NPC, and shuffle. Draw cards one at a time to decide who acts next. If the card is red, any player who has not yet acted may do so (they can decide amongst themselves who should go). If the card is black, the GM acts with any NPC that hasn’t had a turn. When all the cards are drawn, remove a card for each character no longer in the combat, shuffle the remaining ones, and start a new round.

There are four advantages to this system. First of all, it adds an element of tension to the game, as it keeps the players guessing about who goes next. Second, it breaks up player and GM actions so that neither side spends too long waiting for the other. Third, it gives the players the freedom to strategically decide which of their characters should act first. Lastly, it saves a significant amount of time. No rolls, no lists; just shuffle and draw.

One downside of this system is that it makes initiative completely random. In D&D, characters get bonuses or penalties to their initiative roll based on dexterity. Most other RPGs have a similar mechanic. The initiative card system ignores that, effectively stripping speedy characters of one of their advantages. That said, my players love this system and have never once complained that they’re being “cheated” by it. Besides, if you really feel the need, I’m sure you can come up with something similar to my initiative card system that still gives speedy characters the upper hand.


#4. Keep the Pressure On

All too often, combat becomes a matter of simply trading hits until one side falls over or retreats. It could be many rounds until one side is ready to give in, and with nothing to shake things up, each round becomes basically a repeat of the last.

So how do you stop that from happening? Next time you’re planning a combat scene for your adventure, work in some kind of pressure that will force the players to get through it as quickly as possible. Actually, like the sand timer, this is a good method for making any part of the game more exciting, not just combat. It works especially well for a scene that might otherwise drag on indefinitely, such as trying to solve a puzzle or persuade an NPC to help.

My personal favorite is the ever-popular horde of encroaching skeletons. A simple encounter becomes a nightmare when you’ve got an invincible force closing in fast behind you. The PCs can fend off the skeletons for a while, but not for long—they’ll have to overcome the challenge in front of them (be it a battle, a puzzle, whatever) without wasting time. Other forms of pressure I’ve used include: erupting volcano, enchanted tree being cut down, and steam engine about to blow.

Be imaginative, be devious, and most importantly, let the players in on the stakes. Even if their characters wouldn’t have access to this information, it helps to tell the players not just that something bad is on its way, but what it is and how long they have until it arrives.

Fixing Rest in D&D 5E

Tired of dealing with rest in D&D? (See what I did there?) Then read on…


In 5th Edition D&D, players decide how many hit dice they wish to expend after a “Short Rest” (one hour of downtime). A character could take a Short Rest and spend, for example, 1 hit die, and then take another Short Rest and spend 4 hit dice. This makes resting a matter of strategically managing resources, which some players may enjoy. However, as The Angry GM points out in “Hitting the Rest Button,” this makes absolutely no sense if you think of the player’s choices as representing the character’s. In order to obtain the benefit of rolling more hit dice, characters don’t actually have to rest longer, eat more food, or tend to their injuries more closely. The player arbitrarily decides how much their character will heal after each rest, which is deducted from their daily allowance, as if the character could somehow control how quickly their own wounds heal through sheer willpower.

You may argue that the mechanic represents the varied rate at which wounds heal and puts the variation in the control of the player rather than leaving it up to random chance. Even though the player is in control, it doesn’t necessarily mean the character is controlling anything. But, like The Angry GM, I prefer my games to be more immersive than that. By asking the players how much their characters heal, you shatter the illusion that they are their characters. What’s more, I find that the resting mechanic as presented in 5E tends to slow the game down, with little payback. When players are asked to manage their hit dice, more often than not it feels like a chore instead of a strategic deliberation. Especially to people just getting started with D&D (as many of my players are), it’s just one more thing to keep track of on an already crowded character sheet.

That’s why I’ve opted for a fixed rest mechanic in my games. By “fixed,” I don’t mean that I’ve repaired a broken system (though I like to think so). I mean that the rate at which each character heals is set—it’s not up to the players to decide.

My solution is a little different from the ideas The Angry GM came up with:

After a Short Rest, the player rolls half of their hit dice (rounded up) and adds their Constitution modifier to each roll. For example, a Level 8 Fighter with 14 Con rolls 1d10+2 four times. These hit dice are not “spent”—the character may take multiple Short Rests per day, rolling 4 HD each time, but not without seeing some action between each resting period. Also, at a certain point (GM’s discretion, but usually after two Short Rests), the character must take a Long Rest before they can benefit from further Short Rests. In other words, a character heals roughly half of their HP after taking a Short Rest, which they can do around twice per day, but not twice in a row.

This system is roughly equivalent to the 5E resting system (assuming the PCs take about two Short Rests before settling down for a Long Rest), but it’s faster, easier, and more immersive.

After a Long Rest, a player is fully healed, as per standard 5E rules.

If you’re looking for a grittier system, cut the allotted hit dice in half (1/4 HD for a Short Rest and 1/2 HD for a Long Rest). Under those rules, our Level 8 Fighter would roll only 2 HD after a Short Rest and 4 HD after a Long Rest.