Count me as one of the people that has a love-hate relationship with hit points. From a story point, I can completely dance along with the concept that they’re abstract and represent bruises and fatigue and such, and that as characters become more experienced their endurance increases and they can go longer and better avoid serious injury in combat. On the other hand, that’s just an after-the-fact story-gamist rationalization of a mechanic that’s really just a hold over from the game’s miniature wargame days. Then again, it is easy to track, and it’s a tangible reminder to the player that their character is in mortal danger as they tick off how many hit points of damage have been taken. I like that part.
Over the years I’ve ported a lot of different hit point tweaks into my games. The problem with most of them is that they’re serious game-changers. If you use a different system for the player characters but not the monsters and NPCs, it’s like playing a first-person shooter in god mode. If you give the same tweak to the critters, you risk having 1HD monsters wiping the floor with the party (not that that isn’t intriguing, but you’re playing a vastly different game). My favorite tweaks have been the ones that impose penalties to die rolls based on wounds. You’re hurt, so it slows you down. The problem becomes one of how to scale it, and I think I’ve found a compromise solution that I’m going to try in the Pathfinder game I want to run.
For every 5 HP of damage, you get -1 to your die roll. All die rolls. You’re injured. It’s easy to track, because players can see how many 1-2-3-4-SLASH marks are on the paper. A -1 for a 1st level character with only a few hit point makes a big difference, but not as much to 10th level character. The more skilled you become, the more penalties you can take and still be functional.
Damage over Constitution in a single blow is a knock down. If your Con is 12 and you take 12 or more points of damage from a strike, you fall down. You’re not dead, but you’re flat-footed. You can make a Dex check to either not fall down, or not be flat-footed, but not both, so you can stay standing or you can fall down and fight from the ground. It gives some narrative impact to damage, and again it puts characters of all levels on an equal footing but still favors higher-level characters in terms of survivability.
I’m not a “kill characters” kind of DM, so I’m really not worried about character death. If you hit 0 HP, you’re out cold, There’s more story potential for me if you get captured, or the bad guys steal all your stuff and leave you in the middle of nowhere in your underwear, than in killing you off. What I’d rather do is smack you with a point of temporary Con damage all damage equal to Con below 0 HP, cumulative. In other words, if your Con is 12 and you get to -12 HP, your Con is now 11. If you take another 11 points, your Con goes to 10. You live, but you’re going to be sporting those wounds a good long time. Con damage can only be healed magically (i.e. healing skills don’t help), and even then it leaves a permanent scar unless healed within 24 hours. You heal back 1 point of Con per month game time, so you’re feeling the effects of a grievous injury for a good long time. Again, in my mine, this tweak promotes roleplaying. Work that limp, feel that stiff shoulder, baby that broken arm, but show off that gnarly battle scar to the comely wench at the tavern and gain bragging rights among adventurers.
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