Injury & Medical Treatment
A Comprehensive Reference Guide
💉 An ounce of prevention is worth a pound of cure. Treat injuries early and often!
Quick Reference: Injury Severity
| Damage vs Tolerance | Injury Level | Mechanical Effect | Description |
|---|---|---|---|
| = Tolerance | Level 1 | +5 to all rolls | Laceration, sprain, concussion |
| Exceeds by 1-4 | Level 1 | +5 to all rolls | Significant tissue damage |
| Exceeds by 5-8 | Level 2 | +10 to all rolls | Deep wound, fracture, severe hemorrhage |
| Exceeds by 9-12 | Level 3 | +15 to all rolls | Arterial bleeding, organ damage, often incapacitated |
| Exceeds by 13+ | Level 4 | ☠️ DEATH | Exsanguination, organ failure, fatal trauma |
Injury penalties apply to all rolls. Under special circumstances the GM may let a player ignore an injury's penalty; when they do, check Ignore Injury Penalty in the dice roller for that roll.
Dying means exactly that: the character will die from the injury unless it is treated. A Level 4 injury is always death.
Dying means exactly that: the character will die from the injury unless it is treated. A Level 4 injury is always death.
Hit Location Table
Roll 1d10 when injury occurs (or attacker chooses on Critical Success):
1
Head
Vision, hearing, consciousness, mental skills
2
Neck/Throat
Breathing, speaking, rapid blood loss
3
Chest
Breathing, movement, all physical actions
4
Abdomen
All physical actions, internal bleeding
5
Back
Movement, spinal injuries, paralysis risk
6
Left Arm
Using left arm, two-handed actions, carrying
7
Right Arm
Using right arm, weapon use, two-handed
8
Left Leg
Movement reduced, balance, Athletics
9
Right Leg
Movement reduced, balance, Athletics
10
Hands/Feet
Fine manipulation, running, specific actions
Injury Types by Damage Source
🔨 Blunt Trauma (Fists, Clubs, Falls, Impacts)
🧠 Head
- Level 1: Concussion, blurred vision (+5)
- Level 2: Severe concussion, disorientation (+10)
- Level 3: Skull fracture, unconscious (incapacitated)
- Level 4: Traumatic brain injury (DEATH)
💪 Chest & Back (Torso)
- Level 1: Cracked rib, painful breathing (+5)
- Level 2: Broken ribs, difficulty breathing (+10)
- Level 3: Collapsed lung, gasping (+15, cannot run)
- Level 4: Cardiac contusion (DEATH)
🦵 Limbs (incl. Hands & Feet)
- Level 1: Sprain, reduced mobility (+5)
- Level 2: Fracture, severe pain (+10)
- Level 3: Compound fracture, bone exposed (+15, limb unusable)
- Level 4: Crushed limb, shock (DEATH)
🫁 Abdomen
- Level 1: Internal bruising, nausea (+5)
- Level 2: Internal bleeding, worsening (+10)
- Level 3: Severe hemorrhage (+15, bleeding out)
- Level 4: Ruptured organs (DEATH)
🗡️ Lacerations/Piercing (Blades, Bullets, Arrows)
🧠 Head
- Level 1: Deep laceration, blood in eyes (+5)
- Level 2: Severe head wound, arterial bleeding (+10)
- Level 3: Penetrating trauma, brain exposed (dying)
- Level 4: Cerebral hemorrhage (DEATH)
🔴 Neck/Throat
- Level 1: Deep laceration (+5)
- Level 2: Arterial nick, bleeding (+10)
- Level 3: Severed artery (unconscious in 1 round, dying)
- Level 4: Exsanguination (DEATH)
💪 Chest & Back (Torso)
- Level 1: Deep laceration (+5)
- Level 2: Penetrating wound (+10, difficulty breathing)
- Level 3: Sucking chest wound (+15, drowning)
- Level 4: Heart/vessel punctured (DEATH)
🦵 Limbs (incl. Hands & Feet)
- Level 1: Deep laceration (+5)
- Level 2: Severed muscle/tendon (+10, barely functional)
- Level 3: Arterial damage, spurting (+15, useless, bleeding out)
- Level 4: Limb severed (DEATH from blood loss)
🔥 Burns (Fire, Acid, Electricity, Extreme Temps)
🔥 Any Location
- Level 1: Second-degree burn, blistering (+5)
- Level 2: Third-degree burn, tissue destroyed (+10, severe pain)
- Level 3: Fourth-degree, muscle/bone exposed (incapacitated, shock)
- Level 4: Massive burns (>40% body) (DEATH)
SPECIAL: Burns develop infections. Untreated burns escalate on the standard timeline (see Injury Escalation).
Infection System
What Can Get Infected?
⚠️ HIGH RISK (Open Wounds)
- Lacerations/piercing injuries
- Burns (second-degree or worse)
- Compound fractures
- Any injury where skin is broken
✓ LOW/NO RISK (Closed)
- Simple fractures
- Sprains
- Concussions
- Blunt trauma without broken skin
Infection Checks
When to Roll:
- Immediately after open wound in contaminated environment
- Every 24 hours wound remains untreated
- After treating in unsanitary conditions
Roll Survival (Guts + Brawn) • Success = No infection • Failure = Infection develops
Difficulty Modifiers by Environment
| Environment | Difficulty Dice |
|---|---|
| Clean, proper first aid | None |
| Dirty (urban, dusty) | +1d4 |
| Contaminated (sewer, swamp) | +1d6 |
| Highly contaminated (corpses, toxic waste) | +1d8 |
| Disease or poison exposure | +1d10 |
CRITICAL: When infection develops, it becomes a separate injury tracked independently from the wound!
Infection Example
- Player has Level 1 Laceration (arm): +5 to rolls using arm
- Infection check fails
- Player now has TWO injuries:
- Level 1 Laceration: +5 to all rolls
- Level 1 Infection: +5 to all rolls
- Total: +10 to all rolls
Infection Progression Timeline
First 48 Hours (Untreated)
Level 1 Infection (Infected Wound)
+5 to all rolls • Wound red, swollen, warm • Low-grade fever
48-72 Hours (Untreated)
Level 2 Infection (Severe Infection)
+10 to all rolls • Fever, red streaks spreading • Pus, discharge, chills, weakness
72-96 Hours (Untreated)
Level 3 Infection (Sepsis)
+15 to all rolls • Delirium, high fever, confusion • Organs beginning to fail • Incapacitated
96+ Hours (Untreated)
Level 4 Infection (Septic Shock)
☠️ DEATH • Multiple organ failure • Circulatory collapse
Medical Treatment
Required Supplies by Injury Level
These are general guidelines. Requirements are injury-specific: each injury on the character sheet lists its own treatment needs, and those take priority.
Level 1 Injuries
- Bandages, antiseptic
- Basic first aid kit
- Without: +1d6 difficulty
- Improvised: +1d4 difficulty
Level 2 Injuries
- Medical supplies, splints, sutures
- Without: +1d8 or auto-fail
- Improvised: +1d6 difficulty
Level 3 Injuries
- Surgical tools, sterile environment
- Without: Auto-fail
- Field conditions: +1d8 even with supplies
Infections Level 2+
- Antibiotics (oral or IV)
- Without antibiotics: Auto-fail
- Herbal remedies: +1d6 difficulty
Medical Facilities Bonuses
| Facility Type | Medicine Roll Modifier |
|---|---|
| Field conditions | Standard difficulty (no modifier) |
| Clean environment | -1d4 from difficulty |
| Medical clinic | -1d6 from difficulty |
| Hospital | -1d8 from difficulty |
| Teaching hospital/Trauma center | -1d10 from difficulty |
Treatment Difficulty by Injury Level
| Level | Difficulty | Time | Success | Failure | Recovery |
|---|---|---|---|---|---|
| Level 1 | Standard | 15-30 min | Stabilizes, begins healing | Escalates to Level 2 | 3-7 days |
| Level 2 | +1d6 | 1-2 hours | Reduces to Level 1 (1 week) | Escalates to Level 3 | 1-2 weeks |
| Level 3 | +1d8 | 24-48 hours | Stabilizes to Level 2 | Escalates to Level 4 (Death) | 2-4 weeks |
| Level 4 | +1d10 | Days-weeks | Extraordinary save to Level 3 | ☠️ Character dies | Months |
Treatment Difficulty by Infection Level
| Level | Difficulty | Treatment | Success | Recovery |
|---|---|---|---|---|
| Level 1 | Standard | Cleaning, antiseptic, bandages | Clears in 2-3 days | 2-3 days |
| Level 2 | +1d6 | Antibiotics, rest | Reduces to Level 1 | 5-7 days |
| Level 3 (Sepsis) | +1d8 | Strong IV antibiotics, hospitalization | Reduces to Level 2 | 1-2 weeks |
| Level 4 (Septic Shock) | +1d10 | ICU, vasopressors, ventilator | Stabilizes to Level 3 (rare) | Rare survival |
Injury Escalation
How Wounds Get Worse
Every wound has its own escalation interval, listed with each injury on the character sheet (e.g. "12-24 hours").
- Untreated: each time the wound's interval passes, roll Survival. Use the shortest time in the range (a "12-24 hours" wound is checked every 12 hours); the Iron Constitution trait uses the longest instead. Failure = the wound worsens by 1 level. Success = it holds until the next interval. The factors below add difficulty dice to the roll.
- Treated: treating a wound, whether with field medicine or proper care, stabilizes it. It stops getting worse and goes into recovery (see Recovery & Healing). A new hit to the same spot makes it untreated again.
Default Intervals (Untreated Wound Timeline)
Used when a wound doesn't list its own interval.
Level 1 → Level 2
12-24 hours
Injuries worsen or become infected
Level 2 → Level 3
6-12 hours
Severe injuries become critical
Level 3 → Level 4
1-6 hours
Critical injuries become fatal
Level 4
Death
Character removed from play
Factors That Accelerate Escalation
- Continued physical activity with injury
- Dirty/contaminated environment
- Additional trauma to injured area
- Lack of rest
- Dehydration/malnutrition
- Extreme temperatures
Unconsciousness
Causes
- Level 3 head injuries (skull fracture, severe concussion)
- Knockout: an unarmed or blunt Critical Success, if the attacker chooses (see Melee Combat in the Combat Guide)
- Blood loss from multiple Level 2+ bleeding injuries
- Shock from multiple injuries
- Suffocation/drowning (failed Survival rolls)
- Severe infections (Level 3 sepsis)
While Unconscious
- Cannot act, move, or defend
- Automatically hit by attacks
- Not dead (still in game)
- Injuries continue to progress
Regaining Consciousness
🕐 Natural Recovery
- An unconscious character must be stabilized before they can wake
- Once stabilized: Survival roll to wake
- Success = regains consciousness
- Critical Failure = condition worsens
- Single-player: with nobody to stabilize them, an unconscious survivor rolls Survival to wake every hour of game time, stabilized or not
💉 Medical Intervention
- Ally makes Medicine roll
- Standard for shock/trauma
- +1d6 for severe head trauma
- +1d8 for critical injuries
- Success = character awakens (only once stabilized)
Waking up doesn't remove injuries or penalties. A character with a Level 3 injury may still be unable to act.
Multiple Injuries
How Penalties Stack
Different Locations
Penalties add together
Example: Broken arm (+10) + Concussion (+5) = +15 to all rolls
Same Location
A new injury exacerbates the existing one: the existing injury worsens by 1 level, or rises to the new injury's level if that is higher (GM discretion)
Level 2 chest (+10) + new Level 1 chest hit = Level 3 chest (+15)
Death from Multiple Injuries:
- Any single Level 4 = Death
- 3+ Level 3 injuries = Death from combined trauma/shock
- 5+ Level 2 injuries = Survival roll or die from shock
Field Medicine (During Combat)
Stabilizing Wounded Allies
Action Cost: One action (cannot attack that turn)
Roll: Medicine (Brains + Heart)
Requires: Bandages, antiseptic (basic first aid kit)
Roll: Medicine (Brains + Heart)
Requires: Bandages, antiseptic (basic first aid kit)
Success:
- Stabilizes the injury: bleeding stops and escalation is paused
- The injury keeps its level and penalty
Limitations:
- Cannot lower the injury level; that takes proper treatment (see Medical Treatment)
- Buys time: medics stop the clock, doctors and supplies fix the wound
- Level 3+ need professional care after combat
Field Medicine Example
- Ally has Level 2 chest wound (+10 penalty)
- Medic spends action to treat
- Medicine roll succeeds
- Wound is stabilized: it stays Level 2 (+10 penalty) but stops getting worse
- After the fight, proper treatment (+1d6, 1-2 hours) can reduce it to Level 1
Recovery & Healing
Healing Timeline (With Treatment)
| Injury Level | Treatment Required | Time to Heal | Process |
|---|---|---|---|
| Level 1 | Proper medical care | 3-7 days with rest | Heals completely |
| Level 2 | Professional care | 1-2 weeks | → Level 1 (1 week) → Heals |
| Level 3 | Hospitalization | 2-4 weeks | → Level 2 (1 week) → Level 1 → Heals |
| Level 4 | ICU, life support | Months (if survive) | If stabilized to Level 3, then follows timeline |
Healing Rolls
A treated wound doesn't heal on its own. Once its recovery time has passed, roll Medicine or Survival (your choice). Use the longest time in the range (a Level 1 wound takes 7 days); the Quick Healer trait uses the shortest instead.
- Success: the wound improves by 1 level, and its next recovery period begins. A Level 1 wound heals completely.
- Failure: the wound becomes infected. You gain a Level 1 Infected Wound, or your current infection worsens by 1 level. The wound gets another healing roll after another recovery period.
What "Rest" Means
Light Activity
- No combat
- No strenuous activity
- Can walk, talk, light tasks
Bed Rest
- Minimal movement
- Sleep 8-10 hours/day
- Required for serious injuries
Hospital Care
- Professional monitoring
- Proper nutrition, IV fluids
- Fastest healing
Treatment Examples
Example 1: Simple Laceration
Injury: Level 1 laceration, right arm (knife wound)
Penalty: +5 to all rolls
Treatment:
- Medicine roll: Standard difficulty
- Supplies: First aid kit, bandages, antiseptic
- Time: 20 minutes
- Success: Wound cleaned, bandaged, stabilized
Recovery: 3 days healing, 7 days fully healed
If Untreated:
- Every 12-24 hours (this wound's interval): Survival roll
- If it fails: Escalates to Level 2 laceration (+10 to all rolls)
- Infection check (Survival roll) after each 24 hours untreated; failure = Level 1 Infection (+5 to all rolls)
Example 2: Gunshot Wound
Injury: Level 2 penetrating chest wound (9mm bullet)
Penalty: +10 to all rolls
Treatment:
- Medicine roll: +1d6 difficulty
- Supplies: Surgical tools, sterile equipment
- Facility: Clinic or hospital recommended
- Time: 2 hours surgery + ongoing care
- Success: Bullet removed, wound sutured, reduces to Level 1 after 1 week
If Untreated:
- Infection check right away (high contamination)
- Every 6-12 hours: Survival roll; failure = Level 3 (severe internal bleeding)
- At Level 3, every 1-6 hours: Survival roll; failure = Level 4 (death)
🦠 Example 3: Severe Infection
Injury: Level 2 infection (from untreated burn)
Penalty: +10 to all rolls
Symptoms: High fever, red streaks, pus, weakness
Treatment:
- Medicine roll: +1d6 difficulty
- Supplies: Oral or IV antibiotics, fluids
- Facility: Clinic preferred
- Time: Immediate treatment, 5-7 days of antibiotics
- Success: Reduces to Level 1 after 2-3 days → Clears completely
If Untreated:
- 24 hours: Escalates to Level 3 (sepsis)
- 48 hours: Level 4 (septic shock, death)
Quick Treatment Reference
📋 Injury Treatment at a Glance
General guidelines. Each specific injury's own requirements take priority.
| Injury Level | Difficulty | Time | Supplies | Facility | Recovery |
|---|---|---|---|---|---|
| Level 1 | Standard | 15-30 min | First aid kit | Any | 3-7 days |
| Level 2 | +1d6 | 1-2 hours | Medical supplies, antibiotics | Clinic+ | 1-2 weeks |
| Level 3 | +1d8 | 24-48 hours | Surgical, IV | Hospital | 2-4 weeks |
| Level 4 | +1d10 | Days-weeks | ICU, life support | Trauma center | Months |
🦠 Infection Treatment at a Glance
| Infection Level | Difficulty | Treatment | Recovery |
|---|---|---|---|
| Level 1 | Standard | Antiseptic, bandages | 2-3 days |
| Level 2 | +1d6 | Oral antibiotics | 5-7 days |
| Level 3 | +1d8 | IV antibiotics, hospital | 1-2 weeks |
| Level 4 | +1d10 | ICU, life support | Rare survival |
💉 Remember: An ounce of prevention is worth a pound of cure.
Treat injuries early and often!
Treat injuries early and often!