Considerations⌗

Given my last article was about firearms and all the ways they can make Humpty Dumpty fall, it’s probably a good idea to have mechanics for putting him back together.

One thing about the game setting I’m designing is that it’s set in the modern day. While a character is unlikely to die from a simple infection from a cut, they can’t exactly instantly recover from any injury due to a greater restoration spell or anything of that sort.

Some of you may notice the recovery time tables for some of the example injury types are rather harsh, taking weeks or even months to heal fully. That said, there are two major things to keep in mind:

  1. Healing and Injury in my system are designed with the consideration that a player has more than one character. I run a troupe-style game, similar to Ars Magica, due to the modern horror element of the game and its lethality combined with recovery time on mundane medical healing. Players switch between characters in their roster as they’re either killed or put in a hospital for extended periods. This helps get players back into the game quickly.

  2. While magical sources of healing are nowhere near as common as in a traditional OSR system, they’re not entirely absent either. There are still priests who can perform miracles and people with psionic abilities who can knit flesh back together. It’s just far more rare and costly than in standard D&D.

With that clarified, that is not to say these mechanics wouldn’t work in fantasy. Ignoring the fact that medieval medicine was rather nightmarish (and D&D has never much strived for historical authenticity), these rules could still function within a fantasy setting.

Healing mechanics⌗

Natural Healing⌗

  • Characters naturally heal 1 hit point per day of complete, uninterrupted rest. This assumes they are in a safe environment and not engaged in strenuous activity.

First Aid⌗

  • First Aid can be applied once per battle, either during or immediately after the encounter.
  • To perform First Aid, the character must use either:
    • A First Aid Kit or Medical Kit (no check required), or
    • Improvised equipment with a successful Medicine check (DC 12).
  • Successful First Aid heals 1d4+1 hit points, but:
    • Healing from First Aid cannot exceed the damage taken during that battle.
    • Healing cannot exceed the character’s maximum hit points.

Surgery⌗

Surgery is required for severe injuries or conditions beyond the scope of First Aid, such as broken limbs/fractures, Severe bullet wounds, or organ damage. It requires tools and expertise.

Modifiers for Surgery

  • Medicine skill: Bonus equal to skill level in medciine (surgery)
  • INT modifier: Apply the surgeon’s Intelligence modifier
  • Quality of tools: Modifier ranges from -1 (poor tools) to +1 (high-quality tools)
  • Patient’s condition: Modifier ranges from -2 (critical condition) to +2 (stable condition)
  • Assistants: Up to two assistants can help during surgery, granting a +1 bonus each if they have Medicine skill or an INT modifier of +1 or higher.

Difficulty Table

Roll Outcome
2-4 Critical Failure (Added Complications)
5-9 Failure (reroll with -1 modifier)
10-11 Success
12 Critical Success

Results of Surgery⌗

  • Critical Failure: Patient takes 1d4+1 damage, and added complications worsen the condition (e.g., further stabilization or additional care may be required).
  • Failure: Reroll with a -1 modifier
  • Success: regains 1d6+1 HP
  • Critical Success: regains 2d6+1 and subtracts recovery time by 1.

Recovery Time Recovery time depends on the severity and type of injury. Roll on the relevant table and adjust the result by the patient’s Constitution modifier: (Bonuses subtract, penalties add)

1. Minor Injuries (Laceration, minor Burns, Bruise, Contusion, sprains)⌗

Roll Recovery Time
1 1 day
2 1 day
3 2 days
4 2 days
5 3 days
6 3 days
7 1 week
8 1 week

2. Puncture Wound (e.g., Nail, minor bullet wounds)⌗

Roll Recovery Time
1 3 days
2 3 days
3 1 week
4 1 week
5 1 weeks
6 2 weeks

3. Simple Fracture (Arm, Leg, Ribs)⌗

Roll Recovery Time
1 3 weeks
2 3 weeks
3 5 weeks
4 5 weeks
5 8 weeks
6 8 weeks

4. Severe Fracture (Requiring Pins/Plates)⌗

Roll Recovery Time
1 3 months
2 3 months
3 4 month
4 6 month
5 8 months
6 1 year

Notes⌗

The tables are meant to be common examples and can be repurposed for other types of injuries. While I wanted them to be fairly realistic, I didn’t want to make one for every possible type of injury. A lot of the recovery time and surgery rules do rely on Game Master discretion—such as introducing extended recovery times or additional consequences based on the severity and context of the injury.

As a side note, I use a skill system in my OSR game where players must specify the type of skill they choose. For instance, if a player selects ‘science,’ they need to specify the field of science, such as chemistry or physics. The same goes for skills like medicine