Horrible Wounds in OSR games

I don't like death at 0HP. From a player side its abrupt and always feels arbitrary, and from the ref side it's both quite punishing and doesn't cause enough complications.

When characters hit 0HP, I want them to suffer. They get chopped up, start bleeding, lose body parts, get messed up. Characters that drop to 0HP should aquire scars and problems. They should risk death but have a chance to avoid it if swift medical attention is received. It's worth noting that, compared to death at 0HP, these rules are not as forgiving as you might think: being stuck with a PC who's missing two limbs or brain damaged is a pretty big nerf, compared to just getting to roll up a new, perfectly healthy PC.

These are the rules I use. They've been playtested a decent amount and work for what I want them to do. They are also, incidentally, remarkably similar to the rules I put in Wolfpacks & Winter Snow and Esoteric Enterprises. 

Applying Horrible Wounds

Rather than instantly dying on 0 Hit-Points, PCs and other important characters instead suffer specific horrible wounds which may kill them (either instantly or over time) or else leave them with dramatic injuries as their bodies are permanently mutilated.

When damage reduces you to 0 HP or less, or you take any damage when you already had no HP, look at the exact amount of damage dealt and get a result from the list below. It doesn't matter how far 'into the negatives' you are, just look at the result of the dice. Except for the penalties from actual injuries, you can keep on going just fine on 0 HP; adrenaline can do impressive things.

There are 6 sets of wounds to look the damage up on, depending on what caused it. They are:

•         Ballistics, for bullets, explosives and other extremely high energy impacts.
•         Ripping, for knives, teeth, claws, and other ‘sharp’ physical damage.
•         Bludgeoning, for hammers, falling masonry, fists, and other ‘blunt’ physical damage.
•         Burns, for fire, acid, digestive enzymes and other sub-stances that physically corrode, burn or eat away at flesh.
•         Shocks, for electricity and perhaps extreme cold, radiation or other dangers that suddenly stun or shock the body into uselessness.
•         Toxins, for poison, sickness, and other hazardous sub-stances that make the body ill.

Some really nasty damage ignores HP, and goes straight to causing these wounds. This is the sort of thing that would be instant-death in a game without wounds.

Being reduced to 0 in a stat still just kills you instantly; the increasing penalties for lowering stats is a good representation of the body or mind weakening. The same applies to instant death effects (such as some poisons or spells); those just kill you right away. Similarly, against a helpless victim, you can just kill them without needing to make damage rolls. It might be messy and unpleasant, but if they can’t stop you they’ll die eventually.

These rules are best reserved for PCs and significant NPCs and monsters: those important enough to earn a name and a notable place in the fiction. For minor NPCs, wandering monsters and so on, just have them die at 0 HP to avoid the game getting too bogged down.

Ongoing Damage

Sometimes a character is brought to 0 flesh by a source of damage that continues each round or turn; being on fire, breathing in toxic fumes and being immersed in acid are good examples of this sort of thing. For as long as the effect keeps damaging them, they keep taking the appropriate Horrible Wound each round (or turn), with one modification. If they would suffer a Horrible Wound already inflicted on them by that damage source, they instead take the next one down (if that one has also been suffered, look at the one below it and so on until there is a new wound to suffer). In this way, the wounds suffered from ongoing damage will get progressively worse the longer the victim is left, making death near-inevitable without some sort of intervention.

Fatigue

A character who is physically drained and cannot move without difficulty suffers a few penalties. They move as if heavily encumbered and go last in initiative. They regain only 1 HP whenever they would recover HP.

Bleeding To Death

A character who starts bleeding out can survive for as many rounds as they have hit-dice, adjusted by their Constitution modifier. For example, a first level character (who therefore has 1 hit dice) with +2 constitution bleeds to death in 3 rounds.

A character can attempt an Intelligence roll to staunch the bleeding. This takes a round, and if successful slows the bleed to a rate of turns rather than rounds. If failed, then the character loses additional blood as the medic interferes with them; they have one less round of bleed time every time a medic fails to staunch their bleeding.

A character can also attempt to properly treat the bleeding of a character bleeding at a rate of turns. Doing so is more involved, so takes a full turn. If successful, the patient stops bleeding entirely. If failed, then the patient’s bleeding is again accelerated by a full turn.

Magical healing such as Cure Light Wounds or a potion automatically ends the bleeding.

Dead Men Walking

Sometimes death is basically inevitable, but not immediate. This is referred to as being a Dead Man Walking. As a Dead Man Walking, you get one more round to act in, and then you die. If you have a constitution bonus, you get that many extra rounds.

Nothing can be done to stop this. A Dead Man Walking’s death sentence is merely slightly delayed, but still irrevocable.

Healing Horrible Wounds

Some horrible wounds create an immediate effect, such as knocking the victim unconscious or causing them to begin bleeding out. These might be fixed with an appropriate roll and a round (or sometimes turn) spent treating the victim. If the roll fails, the victim suffers additional wounds from the botched procedure; roll a d8 on the appropriate list, and they suffer that wound.

More permanent wounds such as lost body-parts and mutilation cannot be fixed in this way. Sometimes, reconstructive surgery is possible. If doctors are employed to rebuild the character, then the process will likely take several months to be finished (due to waiting times, the search for donors, recovery times and so on) during which they are effectively out of commission. Even in places where the practice of medicine is advanced, access to surgeons this sophisticated is limited.

Alternatively, magic such as Regenerate might be required to restore the body. Spells like Cure Light Wounds are not sufficient.

Ballistic Wounds

This damage table should be used for bullets and explosions, and other high-kinetic-energy impacts.

One damage:

The shot rips through internal organs, starting a slow internal bleed. You’re bleeding out, but at a rate of turns rather than rounds.

Two damage:

The bullet’s impact ruins a leg. With one leg, you're reduced to hopping about or relying on crutches. You can’t run, and get disadvantage (roll twice and take the worse result) to rolls requiring physical agility. If both go, you're on the floor unable to get about at all.

Three damage:

The impact of the bullet ruins an arm. You can’t use that hand for anything. Any rolls that require the use of two hands reduces gets disadvantage).

Four Damage:

A deep wound starts you Bleeding Out. The bullet goes in one side and out the other, and blood’s fountaining everywhere.

Five Damage:

A particularly horrible wound ruins your leg completely. Maybe it’s severed, maybe it’s hanging by sinews, or maybe it’s just a mess. With one leg, you're reduced to hopping about or relying on crutches. You can’t run, and get disadvantage to rolls requiring physical agility. If both go, you're on the floor unable to get about at all.

You are also Bleeding Out.

Six Damage:

A particularly horrible wound gets rid of your arm entirely. Maybe it’s severed, maybe it’s hanging by sinews, or maybe it’s just a mess. You can’t use that hand for anything. Any rolls that require the use of two hands gets disadvantage.

You are also Bleeding Out.

Seven Damage:

You’re shot in the head but somehow survive. You’re Bleeding Out, blood gushing from your ears and mouth. The brain trauma gives you disadvantage to all rolls.

Eight Damage:

You’re going to die. A bullet tears your throat wide open or goes through your lung. You’re a Dead Man Walking.

Nine Damage:

You’re messed up badly. Flesh is ripped to bits, bones shattered. You’re a Dead Man Walking. On top of this, you’re knocked unconscious for a round from the shock of your injuries.

Ten to Fifteen Damage:

A headshot kills you instantly.

Sixteen or More Damage:

You’re dead, ripped to bits in a hail of bullets or shrapnel. What’s left is hardly intact enough to bury or reanimate.

Ripping Wounds

This damage table should be used for physical wounds. Stabbing, cutting, tearing, crushing, grinding; anything where a solid object is tearing up flesh, use this table.

One damage:

The injury fucks your eye up. You take disadvantage to rolls involving perception, since you can’t see properly.

Two damage:

A particularly savage wound ruins a leg. With one leg, you're reduced to hopping about or relying on crutches. You can’t run, and take disadvantage to rolls requiring physical agility. If both go, you're on the floor unable to get about at all.

Three damage:

A particularly savage wound ruins an arm. You can’t use that hand for anything. Any rolls that require the use of two hands reduces suffers disadvantage.

Four Damage:

A deep wound starts you Bleeding Out. An artery’s been cut or there’s a huge injury in your torso, and blood’s fountaining everywhere.

Five Damage:

A particularly horrible wound ruins your leg completely. Maybe it’s severed, maybe it’s hanging by sinews, or maybe it’s just a mess. With one leg, you're reduced to hopping about or relying on crutches. You can’t run, and take disadvantage to rolls requiring physical agility. If both go, you're on the floor unable to get about at all.

You are also Bleeding Out.

Six Damage:

A particularly horrible wound gets rid of your arm entirely. Maybe it’s severed, maybe it’s hanging by sinews, or maybe it’s just a mess. You can’t use that hand for anything. Any rolls that require the use of two hands reduces suffers disadvantage.

You are also Bleeding Out.

Seven Damage:

You sustain a nasty head wound. You’re unconscious for d12 rounds, and Bleeding Out from the head.

Eight Damage:

You’re going to die. A blade through the skull, torso torn open, or something like that. You’re a Dead Man Walking.

Nine Damage:

You’re messed up badly. Flesh is ripped to bits, bones shattered. You’re a Dead Man Walking. On top of this, you’re knocked unconscious for a round from the shock of your injuries.

Ten to Fifteen Damage:

You’re dead. Decapitation, totally ruined chest, skull smashed to bits, or whatever. Death is instant.

Sixteen or More Damage:

Not only are you dead, but there’s not even enough left to bury or reanimate. You’re not much more than chunky salsa.

Bludgeoning Wounds

This damage table should be used for anything that batters at the victim without having a sharp edge or point as fist, bricks, clubs and so on, where the likely result is to bludgeon the victim into submission rather than rip them to bits.

One damage:

It hurts like hell. You lose your next action.

Two damage:

A sharp blow to the head knocks you unconscious for d12 rounds.

Three damage:

You’re knocked out for d12 rounds by the blow, and when you wake up you’re groggy and dazed. You’re fatigued until somebody spends a turn seeing to you, and passes an Intelligence roll to do so.

Four Damage:

A particularly savage wound ruins a leg. With one leg, you're reduced to hopping about or relying on crutches. You can’t run, and take disadvantage to rolls requiring physical agility. If both go, you're on the floor unable to get about at all.

Five Damage:

A particularly savage wound ruins an arm. You can’t use that hand for anything. Any rolls that require the use of two hands reduces suffers disadvantage

Six Damage:

A sharp blow to the head knocks you out cold for d12 rounds. On top of that, the head injury has messed you up badly. The brain trauma gives you disadvantage to all your rolls.

Seven Damage:

You’ve suffered internal damage, and now you’re Bleeding Out. There’s a pretty good chance you’ll be coughing up blood, or else bleeding from the eyes or mouth.

Eight Damage:

You’ve suffered a horrible brain injury. You’re Bleeding Out, blood gushing from your ears and mouth. The brain trauma gives you disadvantage to all your rolls.

Nine Damage:

Something ruptures in your head, doing irreparable and fatal damage to your brain. Although you might be able to cling onto life for a little longer, you’re a Dead Man Walking.

Ten to Fifteen Damage:

You’re killed instantly, your head caved in.

Sixteen or More Damage:

Well, this was overkill. You’ve been squashed into a pulpy mess, so there’s really barely anything left to bury or reanimate.

Shocking Wounds

This damage table is mostly used for electricity, but could also be appropriate for things like cold or psychic damage.

One damage:

It hurts like hell. You lose your next action.

Two damage:

The force of the shock knocks you unconscious for d12 rounds.

Three damage:

You’re knocked out for d12 rounds by the shock, and when you wake up you’re groggy and dazed. You’re fatigued until somebody spends a turn seeing to you, and passes an Intelligence roll to do so.

Four Damage:

The damage has seriously jarred your respiratory system, preventing you from breathing properly and possibly sending you into cardiac arrest. You’re probably spasming, suffocating or otherwise struggling to stay alive. It counts as Bleeding Out, although depending on the injury might not actually involve blood loss.

On top of this, since you can’t breathe properly, you’re Fatigued until you stop bleeding.

Five Damage:

The shock damages your mental faculties. The brain trauma gives disadvantage to all rolls.

Six Damage:

The shock knocks you out cold for d12 rounds. On top of that, the head injury has messed you up badly. The brain trauma gives you disadvantage to all rolls.

Seven Damage:

You’ve suffered internal ruptures, and now you’re Bleeding Out. There’s a pretty good chance you’ll be coughing up blood, or else bleeding from the eyes or mouth.

Eight Damage:

You’ve suffered a horrible brain injury. You’re Bleeding Out, blood gushing from your ears and mouth. The brain trauma gives you disadvantage to all rolls.

Nine Damage:

Your respiratory system seizes up completely, and death is not far off. Although you might be able to cling onto life for a little longer, you’re a Dead Man Walking.

Ten to Fifteen Damage:

You’re killed instantly, the shock stopping all life signs in one fell swoop.

Sixteen or More Damage:

You’re totally obliterated by the force of the shock, leaving only a smell of smoke and ozone. There’s not much left to resurrect or reanimate.

Burning Wounds

This damage table should be used for anything that actually removes your flesh; fire, acid, digestive enzymes, and so on.

One damage:

One damage fucks your eye up. You disadvantage on rolls involving perception

Two damage:

Two damage messes up your mouth and tongue, making al-most impossible to speak clearly. Charisma rolls may be required to communicate through grunts and gestures, and spell-casting is impossible since it requires precise enunciation.

Three damage:

Three damage ruins your face, turning it into a mess of burn scars when it finally heals. You’re ugly as shit now. Enemy reaction rolls are 1 point worse when you’re involved, and you disadvantage on charisma-based rolls. It will need reconstructive surgery to fix.

Four Damage:

Four damage has dealt enough damage to your throat and lungs that you can’t breath properly. You’re probably coughing up blood, suffocating or otherwise struggling to stay alive. It counts as Bleeding Out, although depending on the injury might not actually involve blood loss. On top of this, since you can’t breathe properly, you’re Fatigued until you stop bleeding.

Five Damage:

Five damage ruins your manual dexterity. Your fingers are burnt to useless nubs, or reduced to masses of scar with no sense of touch. You take disadvantage on attack rolls and rolls requiring manual dexterity.

Six Damage:

Six damage ruins your senses. Your nose is burnt away, inner ears ruined. You’re deaf and can no longer smell or taste properly. You take disadvantage on rolls requiring perception. Since you can’t hear, you can’t enunciate properly to cast spells.

You’re also Bleeding Out.

Seven Damage:

Your lungs are burnt away, and so is your face. You’re pretty grim to look at. Enemy reaction rolls are 1 point worse when you’re involved, and you take disadvantage on rolls involving charisma. Plus, you’re now Bleeding Out, and can’t breathe properly meaning you’re Fatigued until you stop bleeding.

Eight Damage:

This is brutal. Your skin is basically gone, and your body is covered in horrific burns. You’re a Dead Man Walking.

Nine Damage:

Nine damage messes you up badly. You’re more ash than flesh at this point, but still clinging to life for a little longer. You’re a Dead Man Walking. On top of this, you’re knocked unconscious for a round from the sheer pain.

Ten to Fifteen Damage:

You’re killed instantly.

Sixteen or More Damage:

You’re dead and the corpse is burnt to oblivion. Nothing but ashes or gunk is left behind.

Toxic Wounds

This damage table is for damage that comes from within the body. Poison, sickness, radiation and so on.

One damage:

You’re nauseous and can’t concentrate. Until somebody sets you down to fix what’s ailing you (spending a turn and passing an Intelligence roll), you’re Fatigued.

Two damage:

Your immune system is horribly, horribly compromised. You get a permanent disadvantage to your

Saves vs Poison.

Three damage:

Your blood is tainted, and your lungs don’t work properly anymore. You recover less slowly than normal. You only get HP back by sleeping, and then a maximum of 1 HP.

Four Damage:

You’re Bleeding Out from the nose and eyes, but at a rate of Turns, not Rounds.

Five Damage:

Your body is trying to vent the poison from it. You sweat foul smelling blood, Bleeding Out at a rate of turns, not rounds. Until you stop bleeding out, you’re also Fatigued.

Six Damage:

Something’s ruptured. You’re bleeding out at normal speed, and the stuff spewing out of your mouth is black and acrid.

Seven Damage:

Things are going badly wrong. You’re Bleeding Out from your mouth and eyes, and even if you survive you get a permanent disadvantage on your Saves vs Poison from now on.

Eight Damage:

This means you’re going to die. There’s just too much nasty stuff in your body, and it can’t cope. You’re a Dead Man Walking.

Nine Damage:

Your organs are shutting down one by one. You’re a Dead Man Walking. Plus, you spend the next round vomiting everywhere, and lose your chance to act.

Ten to Fifteen Damage:

You’re dead, and it’s not pretty.

Sixteen or More Damage:

You die instantly, your body no longer able to hold together under the toxic strain. It’s probably not a good idea to try re-animating the corpse; just burn it for the good of everybody. There’s not even enough left to bury or reanimate.

And there you go. Before long, you'll have a party of PCs missing all sorts of fun extremities.