Injury, Death and Dying

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Health

Hit Points

Hit points are the measure of your ability to continue fighting. 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, 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.

Temporary Hit Points

Certain effects give 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 his 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.

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.

Non-Lethal Damage

Non-lethal damage, which is also called subdual damage, works differently from normal damage. Non-lethal damage is damage which is not intended to kill you, or is from a source which cannot kill you, but which can still impair your ability to continue fighting. Examples can include punching someone with your fist without the improved unarmed strike feat, slashing someone with a (regular) whip, or striking someone with a sap. Exhaustion and even exposure to heat or cold temperatures can also deal non-lethal damage.

When you take nonlethal damage, keep a running total of how much you've accumulated. Do not deduct the nonlethal damage number from your current hit points. It is not "real" damage. Instead, when your nonlethal damage equals your current hit points, you're staggered (see below), and when it exceeds your current hit points, you fall unconscious.

Note that non-lethal damage interacts with temporary hitpoints in an interesting fashion, to wit:

• Non lethal damage does NOT reduce the number of temporary hit points you have.
• Non-lethal damage does NOT reduce the number of normal hit points you have, either.
• Non-lethal damage is recorded in a separate tally from normal damage, and if the amount of non-lethal damage you suffer exceeds your normal hitpoints, you are diabled, even if you have temporary hit points remaining.

Example: A sturdy fighter has 100 hit points. His doughty warlord gives him 50 temporary hitpoints, and his monk friend playfully begins punching him, doing non-lethal damage, because monks can do that.

The first punch of the monk does 45 points of non-lethal damage. (Ow.) The fighters temp hit points and normal hit points DO NOT CHANGE. The warlord is frustrated, because this is bypassing her best mojo.

The second punch does 56 points of damage. The fighter now has 101 points of non-lethal damage and drops in his tracks, despite having 100 normal hitpoints and 50 temporary hit points on top of that.

Example: The fighter is laying there unconscious. The warlord uses Encouraging Word and heals him for 50 hit points. This healing, like all healing, reduces the amount of temporary damage and leaves the Fighter with 51 points of non-lethal damage. The fighter wakes up, ready to go.

Example: The Monk is tired and stops hitting the fighter. The Rogue replaces him. The Rogue doesn't do non-lethal damage, and stabs the hapless fighter for a whopping 80 points of damage. This removes all fifty of the temporary hit points and does 30 hit points of real damage, leaving the fighter with 70 normal hitpoints and 51 points of non-lethal damage. the fighter is able to continue.

Example: The Monk, aghast at the deadly strike of the rogue, hits the fighter again, doing more non-lethal, before the rogue can go again. The monk tanks the roll and does only 20 points of non-lethal. This leaves the Fighter with 71 points of non-lethal damage, but because he only has 70 normal hitpoints due to the damage the rogue inflicted, down he goes again. It's a hard day to be a Fighter.

Example: Exasperated, the Warlord uses Encouraging Word again, and cures the Fighter for another 50 hit points. This removes 50 hit points of non-lethal damage, leaving the Fighter with 21 points of Non-lethal, and also heals the Fighters normal hit points by 30, up to his normal maximum of 100. The Fighter wakes up and decides to start using his shield, all this getting hit and waking up is starting to make him woozy....

Nonlethal Damage with a Weapon that Deals Lethal Damage

You can use a melee weapon that deals lethal damage to deal nonlethal damage instead, but you take a –4 penalty on your attack roll.

Lethal Damage with a Weapon that Deals Nonlethal Damage

You can use a weapon that deals nonlethal damage, including an unarmed strike, to deal lethal damage instead, but you take a –4 penalty on your attack roll.

When your nonlethal damage equals your current hit points, you're Staggered. You can only take a standard action or a move action in each round (in addition to free, immediate, and swift actions). You cease being staggered when your current hit points once again exceed your nonlethal damage.

When your nonlethal damage exceeds your current hit points, you fall Unconscious. While unconscious, you are also Helpless.

Spellcasters who fall unconscious retain any spellcasting ability they had before going unconscious.

If a creature's nonlethal damage is equal to his total maximum hit points (not his current hit points), all further nonlethal damage is treated as lethal damage. This does not apply to creatures with regeneration. Such creatures simply accrue additional nonlethal damage, increasing the amount of time they remain unconscious.

Healing Nonlethal Damage

Unlike normal damage, nonlethal damage is healed quickly with rest. You heal nonlethal damage at the rate of 1 hit point per hour per character level. When a spell or ability cures hit point damage, it also removes an equal amount of nonlethal damage.

Ability Damage

Diseases, poisons, spells, and other abilities can all deal damage directly to your ability scores. This damage does not actually reduce an ability, but it does apply a penalty to the skills and statistics that are based on that ability.

For every 2 points of damage you take to a single ability, apply a –1 penalty to skills and statistics listed with the relevant ability. If the amount of ability damage you have taken equals or exceeds your ability score, you immediately fall unconscious until the damage is less than your ability score. The only exception to this is your Constitution score. If the damage to your Constitution is equal to or greater than your Constitution score, you die. Unless otherwise noted, damage to your ability scores is healed at the rate of 1 per day to each ability score that has been damaged. Ability damage can be healed through the use of spells, such as lesser restoration.

Strength

Damage to your Strength score causes you to take penalties on Strength-based skill checks, melee attack rolls, and weapon damage rolls (if they rely on Strength). The penalty also applies to your Combat Maneuver Bonus (if you are Small or larger) and your Combat Maneuver Defense. A character with a Strength score of 0 is too weak to move in any way and is unconscious. Some creatures do not possess a Strength score and have no modifier at all to Strength-based skills or checks.

Dexterity

Damage to your Dexterity score causes you to take penalties on Dexterity-based skill checks, ranged attack rolls, initiative checks, and Reflex saving throws. The penalty also applies to your Armor Class, your Combat Maneuver Bonus (if you are Tiny or smaller), and to your Combat Maneuver Defense. A character with a Dexterity score of 0 is incapable of moving and is effectively immobile (but not unconscious).

Constitution

Damage to your Constitution score causes you to take penalties on your Fortitude saving throws. In addition, multiply your total Hit Dice by this penalty and subtract that amount from your current and total hit points. Lost hit points are restored when the damage to your Constitution is healed. A character with a Constitution score of 0 is dead.

Intelligence

Damage to your Intelligence score causes you to take penalties on Intelligence-based skill checks. This penalty also applies to any spell DCs based on Intelligence. A character with an Intelligence score of 0 is comatose.

Wisdom

Damage to your Wisdom score causes you to take penalties on Wisdom-based skill checks and Will saving throws. This penalty also applies to any spell DCs based on Wisdom. A character with a Wisdom score of 0 is incapable of rational thought and is unconscious.

Charisma

Damage to your Charisma score causes you to take penalties on Charisma-based skill checks. This penalty also applies to any spell DCs based off Charisma and the DC to resist your channeled energy. A character with a Charisma score of 0 is not able to exert himself in any way and is unconscious.

Ability Score Penalties

Some spells and abilities cause you to take an ability penalty for a limited amount of time. While in effect, these penalties function just like ability damage, but they cannot cause you to fall unconscious or die. In essence, penalties cannot decrease your ability score to less than 1.

Ability Drain

Ability drain actually reduces the relevant ability score. Modify all skills and statistics related to that ability. This might cause you to lose skill points, hit points, and other bonuses. Ability drain can be healed through the use of spells such as Restoration.

Energy Damage (Level Drain)

This attack saps a living opponent’s vital energy and happens automatically when a melee or ranged attack hits. Each successful energy drain bestows one or more negative levels (the creature’s description specifies how many). If an attack that includes an energy drain scores a critical hit, it bestows twice the listed number of negative levels. Unless otherwise specified in the creature’s description, a draining creature gains 5 temporary hit points for each negative level it bestows on an opponent. These temporary hit points last for a maximum of 1 hour. Negative levels remain until 24 hours have passed or until they are removed with a spell such as restoration. If a negative level is not removed before 24 hours have passed, the affected creature must attempt a Fortitude save (DC 10 + 1/2 the draining creature’s racial HD + the draining creature’s Cha modifier; the exact DC is given in the creature’s descriptive text). On a success, the negative level goes away with no harm to the creature. On a failure, the negative level becomes permanent. A separate saving throw is required for each negative level.

Negative Levels

Some spells and a number of undead creatures have the ability to drain away life and energy; this dreadful attack results in “negative levels.” These cause a character to take a number of penalties.

For each negative level a creature has, it takes a cumulative –1 penalty on all ability checks, attack rolls, combat maneuver checks, Combat Maneuver Defense, saving throws, and skill checks. In addition, the creature reduces its current and total hit points by 5 for each negative level it possesses. The creature is also treated as one level lower for the purpose of level-dependent variables (such as spellcasting) for each negative level possessed. Spellcasters do not lose any prepared spells or slots as a result of negative levels. If a creature's negative levels equal or exceed its total Hit Dice, it dies.

A creature with temporary negative levels receives a new saving throw to remove the negative level each day. The DC of this save is the same as the effect that caused the negative levels.

Some abilities and spells (such as raise dead) bestow permanent level drain on a creature. These are treated just like temporary negative levels, but they do not allow a new save each day to remove them. Level drain can be removed through spells like Restoration. Permanent negative levels remain after a dead creature is restored to life. A creature whose permanent negative levels equal its Hit Dice cannot be brought back to life through spells like raise dead and resurrection without also receiving a restoration spell, cast the round after it is restored to life.

Injury and Death

There are four states of critical injury:

Disabled

Occurs at exactly 0 hit points. You gain the Staggered condition and can only take a single move or standard action each turn (but not both, nor can you take full-round 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.

Dying

Occurs at any negative hit point total. You gain the Unconscious condition and can take no actions. You take 1 point of damage at the start of each of your turns, and may roll a CON check to see if you stabilize. The DC of the stabilize check is 10 + your negative hit point total. If you succeed on the roll, you cease losing hit points each round, but remain unconscious. 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 value. NPC's cannot stabilize without some special ability such as regeneration or assistance from an ally.

Dead

When your character's hit points reach a negative total of your CON stat value plus your level, he dies. A character can also die from taking ability damage or suffering an ability drain that reduces his Constitution score to 0 (see Special Abilities). Regular healing spells have no effect on dead characters. Only certain types of powerful magic, such as raise dead and resurrection, can restore life to a dead character.

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. A stabilized character at 0 hit points has the Disabled condition (see above). The stabilized condition can be achieved via a a successful CON check when dying, a First Aid check (Heal skill with DC 15), or via magical healing. See "Stabilizing the Dying" for more details.

Stabilizing the Dying

First Aid can be performed on a dying character by making a Heal check (DC 15). 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 'stabilized' status, regains consciousness and has the 'disabled' status as well. The character is at no further risk of dying until they take additional damage that reduces them below 0 hit points. Note that first aid checks can be performed even if a character has stabilized via a CON check.

If magical healing (e.g. a spell, scroll, potion, etc.) is used on a dying character instead of First Aid, 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 First Aid first, magical healing is a dice-free way to stop a character from losing 1 hit point per round and potentially bleeding out.

Recovering Without Help

A severely wounded character left alone usually dies. He has a small chance of recovering on his own. Treat such characters as those attempting to recover with help, but every failed Constitution check to regain consciousness results in the loss of 1 hit point. An unaided character does not recover hit points naturally. Once conscious, the character can make a DC 10 Constitution check once per day, after resting for 8 hours, to begin recovering hit points naturally. The character takes a penalty on this roll equal to his negative hit point total. Failing this check causes the character to lose 1 hit point, but this does not cause the character to become unconscious. Once a character makes this check, he continues to heal naturally and is no longer in danger of losing hit points naturally.

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, Heal, Goodberries, etc.

Some abilities are only triggered by instantaneous healing, such as the Fighter's tactic "Healer's Friend". 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 Soothing Performance 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. For example, applying the metamagic feat "Echoing Spell" to the 'Heal' spell would change it from an instantaneous healing ability to a persistent healing ability.

Natural Healing

With a full night's rest (8 hours of sleep or more), you recover 1 hit point per character level. Any significant interruption during your rest prevents you from healing that night.

If you undergo complete bed rest for an entire day and night, you recover twice your character level in hit points.