Critical Injuries & Healing

2026-01-24

OSR games have tended not to get into the weeds with injury systems. And for good reasons, though I’d say this is more a constraint of the fiction than a system-level issue.

In your typical D&D setting, among your standard adventuring lot, magical healing and medicine is pretty much ubiquitous, and thoroughly outstrips even bleeding-edge modern medicine by leaps and bounds. Even innocuous spells such as AD&D’s Cure Light Wounds and Cure Disease (2nd and 3rd level spells, respectively) would be totally indispensable if introduced in a modern medical context.

Much of this makes sense in a gameable fictional world; we’re not really interested in roleplaying our characters catching dysentery or dying to an infection from a simple cut, and thus a lot of the nastier, more realistic forms of death we dealt with in our own history are handwaved away via magic in their fictitious analogues.

Though often settings aren’t good at extrapolating the second or third order effects that would have on a setting, if I asked your average person how a reliable cure for cancer or HIV would affect society, they could probably tell you a few things.

Which is the crux of this little introductory ramble. The presupposition of my setting, Be Not Afraid, is that it is the modern day, and like much urban fantasy/horror, people are not generally aware of it, or to the extent that informs their everyday decision making.

Sure, there are psionic abilities, miracles, and magick in my setting (a tiny fraction of a percent of humanity), but even among those who possess such gifts, the powers to heal are even rarer. As such, while my system has magical healing, it tends to be a mid- to late-game type of power, not something accessed early on, if at all.

Hence why my system puts a lot of focus on injury and recovering compared to other OSR systems that more readily handwave that problem away. Furthermore, my system has a higher expectation of lethality compared to most, so the general assumption is players have more than one character, with a focus on troupe play and character rotation.

Mechanics

The mechanics in this artile are refinings and clean ups of mechanics from earlier articles, mainly the First Aid & Sugery and Firearms Rules Compendium articles.

The First Aid & Surgery reals aren’t much different, but I’ve expanded and changed how critical injuries have worked quite a bit, and decided to include all the relevent rules in one article for the sake of compeletion.

Natural Healing & Rest

Characters naturally heal 1 HP 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)
• Improvised equipment with a successfu Medicine check (DC 12)

A Succesful use of First Aid:

• Succesful First Aid stops a bleeding wound
• Successful First Aid heals 1d4+1 hit points but healing cannot exceed the damage taken during that battle.

_{stopping bleedout can be done more than once per encounter/battle}

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 time, tools and expertise.

Modifiers for Surgery

• Medicine skill: Bonus equal to skill level in Medicine
• 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

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 and is able to recover.
• Critical Success: regains 1d6+3 and subtracts recovery time by 1.

Recovery Time

After surgery and treatment, certain penatlies or side effects from an injury don’t go away until a recovery period, this doesn’t necessarily mean the character is hospitalized, but probably means they are not in fighting condition without severe peanlity or risk worsening the condition.

GMs have full discretion to modify these recovery times based on the circumstances or nature of the injury.

• Flesh Wounds: 1d4+1 Days

• Concussion: 2d4 Days

• Broken Limb: 2d4 Weeks

• Broken rib: 1d4+1 Weeks

• Head/SKull Injury: 2d6 Weeks

• Muscle/Ligaments Injury: 1d4+1 Weeks

Critial Hits & Injuries

Upon a critical hit (natural roll of 20) The GM or player rolls for hit location. Each location has a corresponding table by damage type. with the injury determined by the amount of damage the attack did after any damage reduction / resistances are applied.

Hit Location Table (1d12)

Design Note: This system is not interested in accurate anatomical simulation of bodily violence, but more with mechanical impact and visceral description in mind. This mechanic is meant to be used in conjuction with Sacrfice Thy Gear. basically a player may sacrifice a suitable piece of equipment, (armor, shield, weapon.) to not take a critical injury. (however still recieve the damage)

Further these tables don’t encompass all damage types or body plans, for example these tables wouldn’t work well for a giant spider or mutant squid. The GM is at full discretion to overright the result or use them as guidelines as opposed to hard coded result.

Ballstic Injuries

Head Critical Injury - Ballstic

Neck Critical Injury – Ballistic

Chest Critical Injury – Ballistic

Abdomen Critical Injury – Ballistic

Limb Critical Injury - Ballistic

Bludgeoning Injuries

Head Critical Injury – Bludgeoning

Neck Critical Injury – Bludgeoning

Chest Critical Injury – Bludgeoning

Abdomen Critical Injury – Bludgeoning

Limb Critical Injury – Bludgeoning

Piercing Injuries

Head Critical Injury – Piercing

Neck Critical Injury – Piercing

Chest Critical Injury – Piercing

Abdomen Critical Injury – Piercing

Limb Critical Injury – Piercing

Slashing Injuries

Head Critical Injury – Slashing

Neck Critical Injury – Slashing

Chest Critical Injury – Slashing

Abdomen Critical Injury – Slashing

Limb Critical Injury – Slashing

Inspirations

The injury system I’ve outlined here had two major mechanical inspirations. Baptism of Fires Critical Hit tables, which are a series of thematic and gruseome d20 tables for injuries categorized by weapon/damage type.

And Interlock Unlimited a hack of Cyberpunk 2020 which has a good hit location and injury determination system. basing severity by how much damage the weapon does to a specific bodypart.