Combat is a large part of Dungeons & Dragons, and during battles, it is inevitable that player characters will get hurt. There is usually little personal consequence to these fights, and even if a player drops to 0 hit points, they are able to carry on as normal, provided they succeed in their death saves. However, for DMs who want to raise the stakes in their next Dungeons & Dragons campaign setting or add a little realism introducing lingering injuries is a great idea.


It might seem strange to want to create lasting injuries for player characters, but there are some good reasons DMs might want to change their approach to the consequences of combat. Not all campaigns are well suited to introducing lasting injuries, and some Dungeons & Dragons groups might like their heroes to fully heal after every long rest. However, for those who want to introduce this system into their next campaign, here are some ideas and mechanics to help add a little more danger to any future battles.

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Injuries Provide Lasting Impact From Battles In D&D

A man dressed in armor with a cloak and sword heals his fallen female companion. Before them lay the bodies of their slain enemies.

Found in the Dungeon Master’s Guide, lingering injuries are a really excellent way to fix some problems with DnD‘s overpowered long rests. DMs can use the injury table provided or make their own to create some lasting ramifications for players who have fallen unconscious in battle. This is a great mechanic to introduce that can add to the narrative as well as create some fantastic roleplay moments.

How To Use Lingering Injuries And Injury Tables In D&D

Two D&D party members crouch over a dying third, one holding open a scroll, while enemies continue to attack.

Usually, after a combat encounter in Dungeons & Dragons, characters might be described as battered and bloodied, but realistically, they are not. After using healing spells, potions, hit dice, or even a long rest, players are able to carry on with no lasting effects. Introducing lingering injuries changes that by creating consequences under certain conditions so that players’ characters can feel the impact of the constant combat they find themselves in.

The Dungeon Master’s Guide suggests three circumstances when an injury roll could take place. The first of these is the most commonly used by DMs who implement this DnD system, and that is when a character drops to 0 hit points. Along with having to make death saves, this character would also roll on the injury table and suffer whichever corresponding consequence.

The second suggestion is that players only roll on the injury table if they fail one of their death saves by five or more. So if a player rolled under a five or lower on a d20, then they would also suffer a lingering injury. The last suggested circumstance is if the character suffers a critical hit. This is the most extreme option, as critical hits in Dungeons & Dragons are far more likely than a player dropping to 0 hit points.

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A great example of implementing an injury system during a campaign is the High Rollers DnD livestream Aerois campaign. Aerois’ DM, Mark Hulmes, uses a variant of the lingering injuries option found in the Dungeon Master’s Guide, which can be found on his Patreon for subscribers. Under Hulmes’ rules, when a player drops to 0 hit points, they must succeed in a Constitution saving throw where the DC is ten or half the damage taken, whichever is higher. On a failed save, a second d20 is rolled for the result on his homebrew injury table.

This has resulted in several of the party sustaining injuries during the course of their adventures. While some of those have been minor such as cuts and bruises or broken legs, others have had long-lasting consequences. The most notable example is Tom Hazell’s character, Qillek Ad Khollar, who is the best example of the DnD multiclass combo of wizard and cleric.

During a battle in episode 11, “Eye for an Eye,” Qillek lost his right eye. This resulted in the character not only having to wear an eye patch but also having lower Perception. This was roleplayed wonderfully by Hazell during the DnD stream, as Qillek’s keen vision had been an integral part of his role within the group as well as that character’s sense of self.

After Qillek’s death in episode 32, “Whispers of the Void,” he was resurrected and given a powerful magical item from his god H’esper. This a fantastic example of a player adapting their character to an injury and their DM encouraging that DnD roleplay and rewarding them later down the line for that. Qillek’s injuries and later being given the Eye of the Storm all made sense thematically and narratively giving a very organic feel to the use of Hulmes’ injury table.

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Originally, Hulmes also used the critical hits circumstance for injuries; however, he later changed this. Hulmes felt that using the injury table for a critical hit was unfair to his DnD players as this was something out of their control. As he implemented the injury table to encourage and reward tactics, and the strategic use of healing a character dropping to 0 hit points was something the party could influence.

Examples Of D&D Injury Tables And Tips For Using Them

On the left a woman with a prosthetic leg stands proudly sword in hand. On the right is artwork for a combat wheelchair.

The mechanics for lingering injuries in the Dungeon Master’s Guide are very simple and function similarly to using madness tables in a DnD campaign. After determining what the triggering circumstances will be, the player will roll a d20 for the corresponding injury on the table below. The injuries vary from minor scars to much more serious and permanent such as the loss of an eye or limb.




Lose an Eye. You have disadvantage on Perception checks that rely on sight and on ranged attack rolls. Magic such as regenerate can restore the lost eye. If you have no eyes left after sustaining this injury, you’re blinded.


Lose an Arm or a Hand. You can no longer hold anything with two hands, and you can hold only a single object at a time. Magic such as regenerate can restore the lost appendage.


Lose a Foot or Leg. Your speed on foot is halved, and you must use a cane or crutch to move unless you have a peg leg or other prosthesis. You fall prone after using the Dash action. You have disadvantage on Dexterity checks made to balance. Magic such as regenerate can restore the lost appendage.


Limp. Your speed on foot is reduced by 5 feet. You must make a DC 10 Dexterity saving throw after using the Dash action. If you fail the save, you fall prone. Magical healing removes the limp.


Internal Injury. Whenever you attempt an action in combat, you must make a DC 15 Constitution saving throw. On a failed save, you lose your action and can’t use reactions until the start of your next turn. The injury heals if you receive magical healing or if you spend ten days doing nothing but resting.


Broken Ribs. This has the same effect as Internal Injury above, except that the save DC is 10.


Horrible Scar. You are disfigured to the extent that the wound can’t be easily concealed. You have disadvantage on Persuasion checks and advantage on Intimidation checks. Magical healing of sixth level or higher, such as heal and regenerate, removes the scar.


Festering Wound. Your hit point maximum is reduced by 1 every 24 hours the wound persists. If your hit point maximum drops to 0, you die. The wound heals if you receive magical healing. Alternatively, someone can tend to the wound and make a DC 15 Medicine check once every 24 hours. After ten successes, the wound heals.


Minor Scar. The scar doesn’t have any adverse effect. Magical healing of sixth level or higher, such as heal and regenerate, removes the scar.

There are ability penalties for some of the more severe injuries, but these are optional. If the DnD group prefers, the lingering effect could purely be for roleplay purposes, similar to a flaw. The Dungeon Master’s Guide suggests that DMs who use this method reward players with inspiration whenever they use the injury in a meaningful way during roleplay.

Some of the injuries listed might not feel suitable for all groups, and players and DM are encouraged to create their own custom tables. There are also many TTRPG indie design resources available to give inspiration, such as The World of Farland, which has separate injury tables for each damage type. This makes the injury damage dependent, creating a more realistic feel to the injuries sustained.

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Another suggestion is to have different injury tables for different levels. As players become more powerful, typically, so do the enemies they would face, and injuries should match that. DMs could design tables for levels one through six, seven through 12 or 13, and finally, 13 or 14 through to level 20 to make sure that level three players don’t lose an eye to a lucky goblin and powerful level 18 DnD players get a little more than cuts and bruises from their battle with a dragon.

The final piece of advice is that DMs need to make sure there is a way for characters to recover from their injuries so that playing Dungeons & Dragons remains fun for all players. There are a few ways to do this, either through new healing rituals or spells, and it is also a great reason to introduce prosthetics or a combat wheelchair into a campaign, but it is important to give the players options.

Using injury tables with lingering consequences is an excellent way to make combat feel riskier and more impactful. The group’s battle strategy will matter more if as a character goes down, it isn’t as simple anymore as popping some hit points into them. As well as possibly creating additional quests for players, it also gives them some great stories to tell as they engage more with the world of their more realistic Dungeons & Dragons campaign.

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Sources: Dungeons & Dragons/YouTube, Mark Hulmes/Patreon, The World of Farland

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