Tactile Wounds, a Lethal Upgrade to Combat for D&D 5th Edition

Eva Brown

The Problem

Pools have always been a place to lounge and relax, kick back and let the day pass while soaking up the sun. Usually, pools don’t envoke a sense of urgency or panic that dragon claws rending metal and bones should bring forth. So, how can we expect to find that terror in the hit point pool? Additionally, there is an unfortunate tactic in 5e that you wait till your party members hit 0 before bringing them back up as there are no consequences to dropping to 0.

Now adding wounds to a tabletop game are hardly new, there are hundreds of systems out there that introduce the concept, but in my opinion, many of those are too crunchy for fast-paced gameplay. Additionally, there have been some more elegant solutions but they were hard-coded into a system instead of being more rules agnostic. 

A Solution

This system is for d20 based table-top games. The rules will be focused on combining with 5th edition Dungeons and Dragons. This rules set requires a single addition to a character sheet, a figure. This figure can be as simple or fancy as one likes, it could even just be a stick figure made up of boxes drawn in the margins. An example figure is doodled here.

The idea is, all hit points are stamina and represent closely dodging actual damage from a strike, this might mean wrestling an arm free from a wolf’s mouth, barely making it over a barrier before a fireball immolates the area or any other number of nasty close calls. A wound is real and deep damage to your body, the wolf’s teeth ripping flesh, bubbling skin as you’re set ablaze, or an arm ripped off and swallowed by a dragon.



Persistent damage to your character that requires more than basic rest and healing to recover from. There are 3 types of wounds: minor wound, major wound, and lethal wound. major wounds and lethal wounds give the creature the condition Bleeding until the wound is bandaged.


This is a new status condition. When a creature is Bleeding they use a d12 instead of a d20 in any situation that would call for a d20 roll. This lasts until the wound is bandaged.

Major Hit

When you roll 10 over the target’s AC your attack deals a wound. All critical hits, successful attacks against a creature with 0 hit points, and successful attacks against creatures with the Suprised or Restrained conditions are also Major Hits.


When a wound is no longer bleeding out. To bandage a wound a medicine check must be rolled, this DC is 15 for a major wound and 20 for a lethal wound.

Wound Box

The individual subsections of the silhouette of the creature representing sections of body parts. There are 10 subsections on the base humanoid: Head, Torso, Left Arm, Right Arm, Left Hand, Right Hand, Left Leg, Right Leg, Left Foot, Right Foot. 

Wound Threshold

This determines the severity of the received wound. Any Major Hit is automatically a minor wound. If the attack deals an amount of damage higher than the target’s Constitution Score, the Wound is a major wound. If the attack deals an amount of damage higher than two times the target’s Constitution Score, the wound is a lethal wound.


Minor Wound

Mark a Wound Box with a single slash ( / )

Major Wound

Mark a Wound Box with two crossing slashes ( X )

Lethal Wound

Fill in the Wound Box


Draw a Circle around the Wound Box once a Wound is bandaged. When the Wound is healed, erase the circle.


Wounds are the physical harm done to your character, they don’t disappear by taking an hour nap in the deep dark underbelly of a mountain. 

Causing Wounds

When you attack you declare where you are aiming, if no location is specified, it is assumed that you are aiming for the torso. If the attack is successful, the target can choose a different location for the attack to aim before damage is rolled. If the attack was a critical, the target can not change the hit location. Compare the damage rolled against the target’s Constitution to find out what tier of wound is delt. 

If the attack is an area of effect like a fireball and fails their save, divide damage by 10 and apply wounds to every wound box. 

If you would receive a wound in a wound box that already has a wound. Increase the severity of that wound by 1 level. 

Kill Shot

If you receive a lethal wound to the head you die.

Lights Out

If you receive a major wound to the head make a Constitution save with a DC equal to the damage taken. On a failure, you fall unconscious for a number of minutes equal to the damage taken or until the wound is healed.

Subdual Damage

All damage causes wounds and has the chance to kill someone. You can not choose to do less damage or inflict a lesser wound once you’ve rolled damage.

Dropping to 0

When you take a lethal wound, make a Constitution save. The DC for this save is 10 or half the damage taken, whichever is higher. On a failure, your Hit Point total reduces to 0 and you are dying. 

While at 0 hitpoints, your speed is reduced by half and you have disadvantage on all rolls. 


If you take a number of lethal wounds greater than your Constitution Modifier (minimum of 1) you die.

Healing Wounds

Minor Wound

There are multiple ways to heal a minor wound:

  • A successful DC 15 Constitution roll during a Long Rest. (Choose 1 wound per Long Rest)
  • A Lesser Restoration heals 1 wound.
  • A Greater Restoration heals all minor wounds. 

Major Wound

There are multiple ways to heal a bandaged major wound:

  • A successful DC 20 Constitution roll during a Long Rest reduces the wound to a minor wound. (Choose 1 wound per Long Rest) 
  • A Greater Restoration reduces 1 major wound to a minor wound.
  • The Regenerate spell will heal all wounds completely after 2 minutes.

Lethal Wound

A lethal wound means that the body part is severed or mangled beyond natural healing. It is either outright removed from the body or crippled to the point of unusability. 

  • If Revivify is cast within 1 minute of suffering the lethal wound and the limb is held to the stump, the wound becomes a major wound instead.
  • Reincarnation can be used to regrow a limb. Roll on the species table to find from what species of limb you regrow.
  • The Regenerate spell will heal all wounds completely after 2 minutes including lethal wounds.

Changed Feats


You can take 1 more lethal wound before dying.


You have advantage on medicine checks to bandage a wound.

Changed Abilities

Any ability that would normally let a creature or character continue fighting while at 0 hit points and/or while rolling death saving throws instead does not roll at disadvantage while at 0 and their speed is unaffected. 


If a creature has many limbs or otherwise wouldn’t be affected by losing a limb because of a lack of blood or lack of pain you can apply the following tags to creatures.


Undead are immune to the Bleeding condition and can only be killed by a lethal wound to the Torso or Head. Additionally, they do not drop to 0 hit points when they receive a lethal wound.


A Creature with the minion tag dies when they receive a lethal wound. All major wounds are considered lethal wounds for minions.


If a creature has many limbs, tentacles, eye stalks, or any limbs that it can lose without risk of dying, apply this tag. lethal wounds still remove the body part but do not count as a lethal wound in terms of the creature dying and do not have to roll a constitution save to avoid dropping to 0 hit points.