The True Dreamers
4th ed System Shock
Mike Merls, a lead designer for 4th ed offers up this tidbit.
Where Abstract Hit Points Yield Tangible Injuries
The 4e system assumes that a loss of hit points represents a glancing blow, a minor cut or bruise, or some other injury that a character can easily shrug off. Many DMs still describe blood-letting strikes and injuries, but the game pretty much gives you a free pass until you hit zero hit points.
Some players find this less than satisfying. That long, hard fight against a minotaur fades away as the players tick off a few healing surges and continue on. I built the following rules to give a little more sting to attacks that drop a PC. In addition, they add an element that I think makes tough fights more memorable and more important in the adventure.
The system shock rules give a chance that a PC suffers some lingering effects from being dropped to zero hit points. The rules as written confine those effects to the immediate encounter, but you could easily extend the effects’ durations (or the length of a few of the effects) to last until the character takes one or more extended rests.
I went for effects that cleared quickly because I wanted to limit them to the immediate encounter. If I play with the rules, I might modify that based on how they work in play.
When a character rises from below 0 hit points to back above that threshold, he must make a system shock check. This is a 1d20 roll + the character’s Constitution modifier (remember, that does not include half-level, since it specifies Con modifier; this isn’t a Con check). The DC of this check is 10. If the check fails, the character sustains an injury that might hamper him for the rest of the fight.
Roll 1d10 and consult the table below:
1. Sprained Arm: -2 on attacks, checks, and all defenses including AC (save ends).
2. Arm Crippled: Right or left arm useless until after short rest.
3. Wrenched Knee: Immobilized (save ends).
4. Hamstrung: Slowed until after short rest.
5. Foot Smashed: Can’t shift (save ends).
6. Bell Rung: Stunned (save ends).
7. Concussion: Dazed until after next short rest.
8. Gut Shot: Weakened (save ends).
9. Bleeding Wound: Ongoing 5 damage (save ends).
10. Cracked Rib: Vulnerable 2 against all attacks until after next short rest.
If an effect says “until after short rest” it means you suffer the drawback until you take a short rest.
Notes: This is an optional set of rules we can discuss using. I am for them.