Update I: Expanded Criticals, Injuries and Permanent Damage

I think this is original art

I recently shared a heads-up about upcoming changes. As promised, here is the update on expanded critical hits and permanent damage, both of which also include a new side-topic: Injuries. I will start with the main two and later explain injuries and provide more details.

Expanded Criticals

I was thinking of simplifying it, but honestly, I really liked the PDF I linked before and decided to use it. After checking it, I noticed it’s really not that complex. The effects are easy to print and easy to check. As a reminder, the file is here.

So basically, every time you roll a natural 20 on a spell or regular attack, you roll another d20, check the table for your damage type and find the outcome. Only the main damage type is included. For example, if you have a flaming longsword, the weapon is a sword, which is slashing damage. The extra fire damage is not subject to this table.

“Permanent” Wounds and Injuries

Every time you are inflicted a major injury, you get a permanent scar or similar “reminder” wound. Every time you get a minor injury, you have a chance to get one as well. In addition to these cosmetic reminder wounds, major injuries can also potentially turn into permanent injuries, which are even harder to cure. More below.

For clarity, you can heal the regular hitpoint damage from the attack that caused the injury, but to overcome the effects, you need either greater magic or treatment. The idea here is to make Medicine skill more relevant and simple healing spells less of a OTP. Also, injuries add a post-encounter difficulty with a certain urgency. Finally the cosmetic scars enhance the story of the player characters and potentially, recurring villains.


There are three types of injuries. Minor, major and permanent. The list can be found on the critical pdf, on page 7. To summarize, each time you get an injury, you roll a d20 and find out the type of injury. Major ones are more dire than the minors. Permanent ones are not listed in the document. They are essentially the same as major, except they are much harder to cure and players should try their best to avoid them as they have to choose between carrying permanent penalties vs a long down-time.

When you have a minor injury, you make a check at the end of each day. If you weren’t treated, you make Constitution save DC: 13 at a disadvantage and you try to get 3 successes (meaning you require 3 days to heal at least.) If you were treated successfully, you succeed automatically. If you were treated unsuccessfully, you roll regularly. If your benefactor or you roll a natural 20, it counts as two successes, meaning technically it’s possible to be healed in two days. If you or your benefactor rolls a 1, it’s an automatic loss for the day and you get a reminder wound. If you get three losses, your injury becomes a major one.

For major injuries, the process is similar with four changes. One, daily DC is 16. Second, a loss means your successes are reset. Third, three success takes you to minor wounds, not direct cure. Finally, it takes three losses in a row for your injury to become worse. If that happens, your injury is now permanent.

Permanent injuries have the same penalties as major ones, but they are hard to heal. While they technically use the same process, the checks aren’t done daily. Instead, they are done somewhere between weekly to monthly (DM’s discretion), forcing a major downtime for the character. There is no worse condition than permanent injury.

To treat someone, you make a Herbalism check at the same DC as the injury’s required save, ie 13/16 for minor and major injuries. Treatment takes as much time as a long rest, but it’s a strenuous activity which means it does NOT count as long rest. You can take up to two short rests within the time though. You can’t be treated more than once per day, but you can treat more than one person per day (even multiple people at the same time, but DC may increase or you may get a disadvantage.)

Alternatively, clerics and druids can use magic to cure wounds. I thought about adding spells for this reason and I may, but I thought about being more to the point: A cleric or druid can sacrifice a level 2,5 or 7 spell slot to “successfully treat” someone’s minor, major or permanent injury. Alternatively, 2 level higher spell slots can be used to directly heal an injury. For example, a level 4 spell slot will directly cure a minor injury while a level 7 slot will cure a major wound. Other spellcasting classes may also do it if DM allows it.

If both you are treated and also a spell is cast on you, you receive the best result. For example, if a spell was cast but treatment failed; you take the spell’s effect and call it an automatic success. If a spell was cast and treatment succeeded with a natural 20, you take the treatment and you mark 2 successes.


I believe this is one of the systems that take longer to explain than to apply and look more complicated than they really are. Let’s apply it in game then see what works for us and what does not and tweak it afterwards.



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Ekrem Atamer

Ekrem Atamer

Gamer, gaming industry wanderer, development and design enthusiast. Current WIP: TBD