House Rule: Keep Going & How Bad Is It

Here are my house rules for adding a bit of tension and survivability to reaching 0 hp, as well as increase the opportunities for heroic/ desperate self-sacrifice.

If a natural 20 attack roll takes you to 0 HP, you are dead. If a single source of damage does more damage than your Constitution score and takes you to 0 HP, you are dead.

If you are at 0 HP but not dead, you can try to Keep Going. Otherwise you are Down. 

If you are Down you can't do anything. Once combat is over, you roll on the How Bad Is It table.

If you try to Keep Going, you make a Save vs Death. If you succeed you can act normally until next round. If you fail, you are Down.

If you Keep Going, every new round and every time you take damage, you must make a new Save vs Death or go Down. You get a -1 to the Saving Throw for each save you have already made. This negative modifier also applies to your roll on the How Bad Is It table.

This means it gets harder and harder to Keep Going, and the longer you do it the more likely it is that you will die. It's up to you how hard you want to push your luck. You can always chose to go Down rather than try to Keep Going.

How Bad Is It

Roll	How Bad Is It
3 or less	Dead
4	Mangled
5-6	Wounded
7-8	Hurt
9+	Just a Scratch

Dead

You are dead.

Mangled

If you are left to your own devices, roll a d6. On 1-3 you are dead (or otherwise disappear from player control). On 4-6 you show up in a safe place in d6 seasons, with only d6 of your current items still in your possession. Lose two randomly determined stat points and gain one randomly determined point as a result of the ordeal.

If someone brings you to safety and puts you in care you are useless for d4 seasons, at which point you are back to normal. Lose two randomly determined stat point and gain one as a result of the ordeal.

Wounded
You suffer -2 to attack, damage, and saving throws and your move is reduced by 30' (10') until you spend a full week resting and recuperating. Recover 1 HP.

Hurt
You suffer the same penalties as if you're wounded, but a good nights rest and a square meal will remove the penalties. Recover d4 + Con modifier hit points (can't be more than your max HP, can't be less than 1).

Just a Scratch
Maybe you were knocked out, maybe you had the wind knocked out of you. Whatever it is, you pick yourself up and can continue. Recover d6 + Con modifier hit points (can't be more than your max HP, can't be less than 1).

Some of these folks are most likely hurt or worse.
(Bayeux Tapestry)

Some Thoughts

I wasn't sure whether to add the automatic death rules (and I had several different ideas), but in the end I went with some. It makes Shields even more of a big deal (due to Shields Shall Be Splintered), but maybe you want to save them for the critical moment.

How Bad Is It can be used without Keep Going if you'd like.

There are a probably a bunch of edge cases where it makes sense that 0 HP just = dead (you're in a vacuum, you drown, etc). I'm not going to write all that out, just rule on it when it comes up.

It does add a bit of extra survivability, it's true. However, in the game this is intended for Clerical healing is not really available (and no Raise Dead), so I expect that it'll be fine. I do have to test it out in actual play though. I do kind of encourage players to have a back-up character ready at all times - whether it's an additional level 1 rolled up or some sort of henchperson or hireling.

Also, I'm totally applying these rules to NPCs and Monsters as well (where it feels appropriate), even though the rules are phrased to be player facing.

Last but not least, the long recovery times fit in with other house rules I'm planning on using, with the intended effect to give a longer more natural sense of the passage of time. We'll see if it works. If that doesn't suit you, feel free to change those time periods (or let Clerical magic fix everything).