Injury, Death and Dying

Health

Hit Points

Hit points are the measure of your ability to continue fighting...and...stay alive. They are not specifically a measure of how injured you are, in the sense that losing 10% of your hit points does not mean the loss of 10% of your body. Instead, it represents a 10% reduction in your physical resources which permit you to fight and live, such as how much blood you've lost, how winded you are, etc. At the end of the day, it is a very abstract value, and cannot be converted into a formula to decide how many of the 206 bones in your body (assuming your character is human) are broken at any given time.

Of course, once your hit points go below 0, your character is no longer able to fight. And is at risk of death.

Temporary Hit Points

Certain effects can grant a character temporary hit points. These hit points are in addition to the character's current hit point total and any damage taken by the character is subtracted from these hit points first. Any damage in excess of a character's temporary hit points is applied to their current hit points as normal. If the effect that grants the temporary hit points ends or is dispelled, any remaining temporary hit points go away. The damage they sustained is not transferred to the character's current hit points.

When temporary hit points are lost, they cannot be restored as real hit points can be, even by magic.

While temporary hit points may have a duration lasting minutes or even hours, this is only in preparation of combat. Once an initiative roll is made (and combat begins), all temporary hit points currently applied or applied during the fight have their duration reduced to the end of combat (when the initiative order is dismissed) or until they are removed through damage, whichever is sooner.

If you already have temporary hit points, and a new effect would grant you more, they do not stack. Instead, you either keep your current temporary hit points (if they are greater than the new source of temporary hit points), or you replace your temporary hit points with the new source of temporary hit points (if the new source is greater than your current temporary hit points).

Types of Damage

Damage

Damage is the classic measure of injury, distress or debilitation that has been inflicted upon a creature as a result of some dangerous event or activity, such as getting hit by that heavy thing the troll is swinging around. Damage is an abstract measure, much like hit points, which doesn't correlate to any specific amount of injury, blood loss or structural/skeletal damage to your character's form. However, damage is used to describe the declining ability of your character to continue fighting.

The amount of damage dealt by any particular creature, weapon or object can vary significantly, and depends on a number of factors, such as the wielder's (or creature's) strength, level (or CR), and the type of weapon or object being used. Other sources of damage may include traps, falling from a height, spells, and even environmental effects such as extreme cold or heat.

When something damages your character, it follows the following steps:

1. The damage is reduced by any factor you may have which reduces incoming damage by a percentage (such as insubstantial, which reduces damage by 50%)
2. It is then reduced by any DR or ER which is applicable to the type of damage you have received
3. The remainder is applied first to any temporary hit points your character may have
4. Finally, the remaining damage is applied to your hit points.

Sometimes you multiply damage by some factor, such as on a critical hit. Roll the damage (with all modifiers) multiple times and total the results. Note that when you multiply damage more than once, each multiplier is added to the others, not multiplied. For example, if you critically hit with an axe, which does triple damage on a hit, and that damage is doubled for some secondary reason (such as a spell effect), the total multiple is x5, not x6. It's still going to hurt a LOT.

Damage can be healed with spells, but also heals naturally with rest.

Injury and Death

You can always tell, at a glance, the general health of any creature, among the following statuses: unharmed, injured, bloodied, staggered, unconscious, or dead. This does not require a skill check, and anyone can do it. It is only when you want to know the precise amount of hit points a creature has lost that a Heal or Divinity check is necessary.

Note that none of these statuses are considered a 'condition', and they cannot be removed with abilities that normally remove conditions.

Unharmed

Your current hit points are equal to your maximum hit points. The presence or absence of temporary hit points are not factored into this.

Injured

You are no longer at maximum hit points, but still have greater than half of your maximum hit points.

Bloodied

You have been reduced to half your maximum hit points (rounded down) or fewer. Some special abilities have greater effects against bloodied creatures. It is generally good form to announce when you become bloodied, and for the GM to announce when a monster has become bloodied.

Staggered

You are at exactly zero hit points. You may take a single move action or standard action each round (but not both, nor can you take full attack or full-round actions). You can still take free actions, but not swift or immediate actions. You can take move actions without further injuring yourself, but if you perform any standard action (or any other strenuous action), you take 1 point of damage after completing the act. Unless your activity increased your hit points, you are now at -1 hit points and dying.

Staggered does not apply to monsters, since they are slain when they reach 0 or fewer hit points. If a monster needs to remain alive for plot reasons, being reduced to exactly 0 hit points knocks the creature Unconscious.

In general, very few creatures are capable of inflicting the staggered condition as a special attack (though all of them can do it through damage, given the opportunity).

Unconscious

You are no longer capable of taking actions, and pass out. You fall Prone and become Helpless. Unconsciousness results from having your current hit points drop below zero, but not drop so low that you are dead (a character is dead when their current hit points are less than or equal to their Character Level + CON score (not modifier)). Unconscious includes all the penalties of Helpless and Prone, including susceptibility to coup-de-grace attacks. Unconscious characters cannot take any actions except some free actions (such as saving throws), though some free actions are simply not possible (such as speaking). The GM is the final arbiter of which free actions are permitted.

Any conditions you were suffering under, and any bonuses or buffs you have applied to you (as from spells) typically remain in effect while you are unconscious (though they may not provide any benefit until you regain consciousness, as with fast healing). Any time limit on the conditions or buffs (i.e. 'until the end of your next turn', etc.) still tick down while you are unconscious.

Generally, monsters die upon reaching negative hit points, rather than becoming unconscious. If a monster needs to fall unconscious for story reasons, they generally just stop accumulating damage once they reach 0 hit points.

Dead

When your character's hit points reach a negative total of its CON stat value (not your CON modifier) plus character level, it dies. A character can also die from certain status conditions, spells, or special abilities. Regular healing spells, such as Cure Critical Wounds (Bard Spell), and potions, scrolls or other effects which make use of healing spells, have no effect on dead characters. Furthermore, a character's fast healing (if any) ceases after death.

Only certain types of powerful magic, such as Raise Dead (Cleric Spell) and Resurrection (Cleric Spell), which specifically state they restore life to slain creatures, may be used to bring a character back from death. Note that being brought back to life via these sorts of spells does not cause you to become undead. Becoming undead requires a different sort of spell entirely — typically one which animates the corpse through the introduction of a new soul, or torments the departing soul into becoming a malevolent spirit.

Any status conditions, bonuses, buffs, or debuffs that a creature had applied to them are immediately removed when a creature dies, unless the ability which applied the condition or bonus explicitly states that it can persist even after a creature dies (such as Cursed, or Ability Drain).

Monsters typically die upon reaching 0 or fewer hit points.

In addition, there are two statuses which can occur when a creature is unconscious: dying and stabilized. Unlike the statuses above, these are not detectable from simple observation, but only through examination with either a Heal or a Divinity check.

Dying

Any time your hit points are at a negative number, but you are not instantly slain (i.e. your hit points are below zero, but not less than a negative total equal to your CON score (not modifier) + your character level), you are Dying. You gain the Unconscious condition and can take no actions. While dying, you must make a death check at the end of each of your turns, as a free action, to determine whether you continue to bleed out, or stabilize. A death check is resolved as follows:

Death Check: d20 (no modifiers*) vs. a DC of 12

* – rare modifiers to this check exist, such as from the Diehard feat.

If you succeed on the roll, you remain unconscious, but you stabilize and are no longer dying. If you fail the check three times in a row (over the course of three rounds), you die.

If you reach a negative hit point total of your CON stat (not stat mod) plus your level, you die. Most NPC's die when their hit points go below zero, but some NPC's only die when they reach negative their CON stat (not modifier) plus Level. NPC's cannot stabilize without some special ability such as regeneration or assistance from an ally.

Stabilized

Can occur at any hit point value of 0 or less. A stabilized character is no longer dying. A stabilized character with negative hit points is still Unconscious and cannot take any actions. The stabilized condition can be achieved via a successful Death Check to stabilize, a Heal check from an adjacent ally, or via magical healing. See "Stabilizing the Dying" for more details.

Detecting Afflictions

Status conditions may or may not be noticeable with a visual inspection, depending upon how subtle or unusual they are in their application. Afflictions such as Prone are very obvious on a humanoid or other 'normally' shaped creature, but not so obvious on a fourteen-limbed aberration from another dimension and nearly impossible to tell on a worm.

Other examples include Petrification, which may or may not be immediately obvious, depending on lighting, senses, etc. Hindered and entangled are often very obvious (the victim is nearly buried in goop), but a mental entanglement may not be visible at all.

To reflect the vast array of potentials here, the GM must adjudicate what afflictions are visible, and which are not. In all cases, a Heal or Divinity check will reveal most afflictions, and other skill checks (such as Sense Motive, Barter, Knowledge, Local, Reason, etc.) may be situationally useful to reveal various subtle afflictions.

Stabilizing the Dying

An adjacent ally can attempt to stabilize a dying character by making an Easy DC Heal check versus the level/CR of the dying character. If the check succeeds, the character's hit points are restored to 0, regardless of whatever negative total they previously sustained. The character replaces the 'dying' status with the 'staggered' status, but remains Prone. The character is at no further risk of dying until they take additional damage that reduces them below 0 hit points again. Note that Heal checks can be performed even if a character has stabilized on their own via a Death Check (see Dying, below).

If magical healing (e.g. a spell, scroll, potion, etc.) is used on a dying character instead of a Heal check, damage is restored from whatever negative value the character is currently at, but the character replaces the 'dying' status with the 'stabilized' status. While less efficient than performing a Heal check first, magical healing is a risk-free way to stop a character from potentially bleeding out due to failed Death Checks to stabilize.

Recovering Without Help

A severely wounded character left alone usually dies. They have only a small chance of recovering on their own. While dying, every failed Death Check to stabilize brings them closer to death, and three such failed checks causes them to die.

Furthermore, even after they stabilize, an unaided character remains unconscious, and does not recover hit points naturally. Instead, after a full night's rest (typically 8 hours), they must make a single Death Check (versus the same DC of 12). Failing this check causes the character to begin 'dying' again, starting up a new cycle of Death Checks to stabilize, and potentially resulting in their death. Characters that succeed on this check begin recovering hit points normally (at the rate of 1 hit point per character level per full day of rest), and are no longer in danger of needing to make additional Death Checks to stabilize.

Unattended characters cannot gain the benefits of Long Term Care (see Heal), even if they have the Heal skill themselves. They are simply too injured to provide that degree of care for themselves.

Types of Healing

Instantaneous Healing

Various abilities and spells can restore hit points. Spells which result in an instant influx of hit points to the target creature are deemed Instantaneous Healing. This does not refer to how long the spell takes to cast, only to the fact that the healing effect of the spell expends all of its beneficial effects on the target creature immediately upon the completion of casting. Examples include Cure Light Wounds (Cleric Spell), Heal (Cleric Spell), Goodberry (Druid Spell), etc.

Some abilities are only triggered by instantaneous healing, such as the Fighter's tactic "Healer's Friend", or the ambergold dweomermetal (when used in armor or a shield). In such cases, persistent healing (see below) does not trigger these abilities.

Persistent Healing

Persistent healing is healing which occurs over a period of time. Healing from rest is considered persistent healing, but so is regeneration and fast healing. A warlord's Exhortation ability or a bard's Song of Soothing are also persistent healing abilities. Even a spell which has a large healing effect the first round it is cast but then provides additional healing in future rounds is considered persistent healing.

Fast healing is a fixed amount of healing that occurs each round during combat. For example, "fast healing 5" would heal the owner of that ability by 5 points each round at the start of each of their turns, but only during combat. Outside of combat (i.e. when there is no initiative order), fast healing does not operate, except in cases where the owner of the ability is suffering from any of impaired, crippled, or maimed conditions. In that case, the fast healing works at a rate of its listed amount per 10 minutes, and only if the owner of the ability is resting. Once the fast healing ability has healed enough to remove the impaired, crippled, or maimed status conditions, it ceases working until the next encounter begins.

"Fast healing" and "regeneration" are identical terms.

If a creature with fast healing is reduced to 0 or fewer hit points, or they are denied all actions during their turn, their fast healing ceases to function, and they must rely on other means of healing in order to recover. As soon as they are restored to at least 1 hit point, or are able to take any actions during their turn, fast healing begins functioning again. Fast healing does not work if the creature is killed.

Natural Healing

With a full night's rest (8 hours of sleep or more), you recover 1 hit point per character level. The 8 hours of sleep need not be consecutive, but need to occur within no greater than a 12 hour period, or your rest was too interrupted to receive any natural healing benefit from it. Natural healing is considered a form of persistent healing, and therefore does not trigger abilities that refer to 'instantaneous healing'.

If you undergo complete bed rest for an entire day and night (24 hours consecutively), you recover twice as many hit points (typically twice your character level in hit points).

While not specifically related to hit point recovery, a full night's rest also restores 1 point of ability damage to each ability score which sustained damage. A full day's rest (24 hours) restores 2 points of ability damage to each ability score which sustained damage. See Ability Damage for details.