[RPG] Are there consequences to being reduced to 0 HP multiple times in combat


I was running a game a few weeks ago. In short, during combat the thief and the warlock were both knocked unconscious. Each were brought back by the cleric with healing word and cure wounds. New round, both get knocked out again. Repeat this for 3 rounds until the barbarian manages to end combat. The party loots the camp and wants to keep travelling.

At this point, I was thinking to myself, "I feel like taking that kind of beating should mean something." But at the time, I did not remember if there was a rule for that.

Are there any rules that would give some sort of penalty to the PCs in this situation?

Best Answer

Optional rule: Lingering Injury

There are no rules in the PHB limiting how often a PC can get up after being knocked to 0 HP. For DMs who don't like there being few consequences for dropping to 0 HP, in the DMG on page 272 there is an optional rule for lingering injuries that covers any PC who:

  • Receives a critical hit
  • Drops to 0 HP but is not killed out right
  • Fails a death saving throw by 5 or more.

Experience with this rule

I've had two DMs use this rule, and each of them chose after a time to get rid of "receives a critical hit" triggering criteria. Why? Because the PC's receive many attack rolls against them; eventually everyone ends up with a lingering injury. All that the basic critical hit does in this edition is increase damage (HP reduction) done on that attack.

There are 9 choices, determined by a d20 roll. If you do the math a bit, as one of my DMs did, you realize that by level 11 everyone in the party will be wearing an eyepatch and be short of an eye, at the least, and will likely have multiple other performance inhibiting effects. And that's without having bad luck. You can be blind by level 3 with a little bad luck.

There is already a penalty at 0 HP: the unconscious condition

If enemies make attacks on unconscious PCs, it already causes two failed death saves, since the attack is automatically a critical hit if it is done by a creature within 5 feet.

  • The creature automatically fails Strength and Dexterity saving throws.
  • Attack rolls against the creature have advantage.
  • Any attack that hits the creature is a critical hit if the attacker is within 5 feet of the creature.

When you are at 0 HP, a critical hit = two failed death saving throws.

Damage at 0 Hit Points. If you take any damage while you have 0 hit points, you suffer a death saving throw failure. If the damage is from a critical hit, you suffer two failures instead. If the damage equals or exceeds your hit point maximum, you suffer instant death. (Chapter 9, Combat)

Recommendation(if you want to apply this rule)

Apply this lingering injury effect after the battle if the PC dropped to 0 HP but wasn't killed outright, and / or missed a death saving throw by 5 or more. (Since you only roll those when you drop to 0 HP anyway, that is a supplement to the "drop to 0 HP" criterion). One of my DMs allowed the lingering injury to be alleviated by receipt of magical healing.

  • Caveat: In both cases I noted above the DM"s first floated the idea to the players and got consensus - they didn't just add it on. I suggest that you do likewise if you think it's a good optional rule. Experienced players (we all were) are less likely to find this change to burdensome. @dsollen made a good point in a comment about the negative impact on the PC often being unpallatable to less experienced players and new players. If they get dropped to 0 HP a lot, they may be struggling tactically and adding further negative impact to 0 HP may not improve their play experience.

Thoughts on how to accept this game feature

  1. Mechanically, this game offers a way for HP at 0 to force a decision: to expend a resource or not. (Example: do I burn a spell slot on Healing Word to get Grax the Barbarian back on his feet, or do I {do something else}?
  2. Lying around dead while everyone else is fighting is rarely fun for a player.
  3. Having a way to get your ally back up and back into the fight promotes and rewards teamwork. The core conceit of this game is that it is a party, a team, of characters with different talents and gifts that are out adventuring to achieve {X objective}. Why remove a way for one team mate to get them back into play? That way the player gets to take a turn ...

"I feel like taking that kind of beating should mean something."

Is the problem that combat does not feel dangerous or deadly enough to your group?

Optional Rule: System Shock

In a related massive damage rule meant to emphasize "Combat is Dangerous and Lethal!" on DMG page 273, there is a system shock table that forces a Constitution save based on whether or not a PC took over half of their damage in one blow. This one penalizes PCs who do not pump Constitution, and those unlucky enough to be hit with a natural 20 roll by an enemy who then does double damage. If you apply this to monsters as well, to be fair, combat can change quite a bit.

I dropped this one after two sessions; it slowed combat down, and "stunned" (See Conditions, Appendix A) is a powerful condition (for the creature's opponents) to have applied to any creature. Most cases of stun require magic to apply, or require a Monk.