Some people (oldies and grognards, like me) remember when D&D was a lot more lethal for player characters (PCs). 5e changed all that. Now players have a suitably comfortable time with only a few chances of actually dying in a campaign (players don’t really like their characters dying unless its part of a game-changing event e.g. sacrificing yourself to kill the big bad).
Here are some…modifications…to make things a little tougher.

Wounds
- When an attack hits that is 5 over the required AC, the PC or creature is wounded (a new condition). The wound condition causes 1d4 HP bleeding damage per turn until the PC uses an ACTION to bind it.
- When an attack hits that is 10 over the required AC, the PC or creature is wounded (as above) and stunned for 1d4 rounds. The PC can make a save to recover from the stunned condition at the end of each of their turns – the DC is 8 + the amount of damage they took in the attack.
- When an attack hits with a natural 20, damage dice are doubled and modifiers added (as usual), plus the PC or creature suffers wounds per the table below (roll 1d4):
- Head: PC or creature is wounded (as above) and stunned for 1d4 rounds. The PC can make a save to recover from the stunned condition at the end of each of their turns – the DC is 8 + the amount of damage they took in the attack. Once they save they have DISADV on WIS (Perception) checks.
- Arm: PC or creature is wounded (as above) and has DISADV on attacks and STR checks/saves.
- Leg: PC or creature is wounded (as above) and loses 10 ft. of movement per round and has DISADV on DEX checks/saves.
- Torso: PC or creature is wounded (as above) and gains one level of Exhaustion.
Short and Long Rests
PCs can only recover a maximum of 2 HD per Short Rest (obviously if they have only 1 HD left they can only spend that much) and a maximum of half their HP Max per Long Rest rounded down. A single natural 20 wound from the table above is recovered during a Long Rest. If a PC has multiple natural 20 wounds, they need to take that many Long Rests to fully recover.
Death Saves
Unconscious PCs don’t get any death saves. Instead, the unconscious PC suffers 1d4 wound bleed damage each turn after they reach 0 HP. When the accumulated bleed damage below 0 reaches the level of their CON expressed as a negative e.g. CON 16 means ‘-16 HP‘, the PC dies.
Another PC may use an ACTION to bind the unconscious PC’s wounds – this heals 1d8 HP of negative damage, but does not bring the unconscious PC above 0 HP. The other PC must continue to bind the unconscious PC’s wounds (using an action to heal 1d8 HP each round) until they overcome the number of HPs lost due to bleed, whereby the unconscious PC is stabilized. Otherwise, the unconscious PC bleeds to death.
If you hadn’t guessed by now, this makes your games incredibly tense and incredibly lethal. But don’t forget monsters use the same rules, so combat is shortened considerably. Play at your own risk!
Game on!
Steve 🙂
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