Dungeon World has this type of mechanic, where players can choose for their characters to sustain an injury rather than lose health points. I'm a fan of that concept, and thought I'd share some of my own ideas here for implementing that in the d20 system.
Injures and Wounds
- Fractured arm makes it difficult to hold items or cast spells (-2 attack, worth 10 hp)
- Fractured leg makes walking or running difficult (base speed -10 ft., worth 10 hp)
- Fractured ribs make it hard to do anything (-2 Str and Dex penalty, worth 10 hp)
- Mild head trauma impedes focus (-1 attacks, skills, saves, and ability checks, worth 15 hp)
- Broken arm cannot hold weapons or shields or cast spells (arm cannot be used in actions, worth 30 hp)
- Broken leg cannot support weight (base speed = 5 ft., worth 30 hp)
- Broken ribs impede nearly all actions (-6 Str and Dex penalty, worth 30 hp)
- Severe head trauma halves capability (take either a move or a standard action each round, worth 50 hp)
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