Well, the simple answer is we do the traditional method: person gets hit, they lose HP, if they reach 0, they're considered dead. Simple, easy, efficient, and frankly, quite boring. I mean, I know we want to simple to understand and everything, but frankly I think we can make it a little less dry than that.
One of the games I've been drawing a lot of inspiration from is the Star Wars Saga Edition RPG, it had a limited release about 5-6 years ago, and it runs on a simplified d20 system (think Pathfinder but slightly easier). The way it does healing is it has a condition track running down the right side of the character sheet, how it works is that if a character takes a quarter of his current HP in damage from a single attack, he moves down the condition track one level. Each condition essentially gives a decent amount of negatives that stack on each other as you go down. So the first time, you get -1 to basically all stats, next time is -2, next is -4, then -8, and finally death. An extended rest heals this damage.
I feel that this can be a little harsh, because as you start falling down the condition track, it is easier to keep going down the rungs until you're dead. (Since you have lower and lower HP so it's easier and easier to lose a 4th of it) However, I also like it because it adds a certain degree of realism to the game that a lot of RPGs are missing. If your character has been stabbed over and over again, he's going to start slowing down, he's going to get weaker, he's going to lose blood. The weaker he gets, the easier and easier it becomes to finish them off. Makes a ton of sense honestly.
I like it, I like it a lot.
Another idea that I had, and was mentioned prior to this post, was the idea that when certain things happened to a player's health, like it reaching 0 for the first time, or a player lose a quarter of his health the first time, a previously sealed compartment could be opened, showing the rules for what happens next. This would add to the panic and so on, and would add to the realism, because honestly, how many people know how to deal with a dying person, until the first time they see it? And how many people know what happens to them when they are in extreme pain until they've actually experienced extreme pain?
After they opened them, the rules would be known to the players, much like we know when something bad happens to us. They could reference them whenever they wanted, etc. I think that this idea would be interesting, especially if coupled with the cards idea.
One other concept I've had came about from Left 4 Dead and Left 4 Dead 2, one of the things that is involved in the game is that sometimes another teammate has to help out, like if a person falls and is narrowly holding on, or if they get pinned by a Hunter, another player has to help bail them out. I think that we could use this quite liberally in game. Give enemies like wolves the chance to pin a player, if a player is pinned, they can make unarmed strikes at a negative penalty, but they cannot stand until the wolf is dead or distracted, allow another player to kill or distract.
Another thing is that if the player gets to let's say, a quarter of their health, their speed is reduced dramatically, however, if another player carries them, they can move their normal move speed, or just slightly under it. This would allow players to stick together and try to help each other out more. However, if we use magical healing, or use too much magical healing, they will never use this option, which brings me to my next point.
Magically healing. It is the bane of a realistic game's existence, which is why the vast majority of realistic games don't even bother dealing with it. However, it's in almost every fantasy game or novel, and it makes sense, health is important, and if magic has the ability to improve someone's health, then by golly, magic ought to be used for just that. But there could be some way to limit it, my suggestion is to offer magical healing to the faithful, but limit it in some way, such as by making it go off your turn/rebuke amounts instead of spell slots, or only allow so much HP to be healed per day, this HP can be spread around to multiple characters, but it cannot go past a limit. I like the second idea better personally. Or maybe, the faithful can heal, but he starts taking negatives to his Faith total for the day. (Maybe he can heal 3-4 HP per point of Faith that he expends, he gets them back the next morning, but his Faith will be hurt until then, making him more thrifty with the healing)
As for mundane healing, I think we should allow this in the game as a skill. If you pass a certain DC, you heal 1d3 points of another person once after each encounter that the character is injured. (Can't do it to yourself) With a first aid kit, you increase it to 1d3+2. This makes it to where you can help them heal, however, you can't just keep spamming the check until they're up to full health. Also, mundane healing generally takes time, sure you can slap a bandage on it and disinfect it, but it's not like you automatically close up the wound or something. They're still bleeding and still hurt, which is why mundane healing can't heal too terribly much.
Now the last thing I need to cover is death, how it works, what happens after, etc.
First and foremost, I want to do away with resurrection spells and the like. End of discussion. They make it to where people who play their characters stupidly can have decent longevity. I dislike the very idea of it, and it pisses me off when it happens in game. (Well Craig died charging that 4 headed dragon ... we should bring him back!) Yes, I understand that there's bad luck, and I understand that sometimes people go out in a blaze of glory, but don't bring them back, please?
Now as for death mechanics, I like the D&D mechanics overall, you get reduced to -10 HP (too much in my opinion, let's make it -5), then you get 3 chances to make a FORT save, if you fail all three, the character dies. Okay, so I think it's a bit easy, let's make it one save and -5 HP, that makes it a tad more realistic but still gives them a fighting chance.
But I want to add one caveat: if they fail the save, the party has one round to heal them at least 1 HP, through mundane or magical means, to give them a second chance at the save. Or if they bring them to 1 HP or more, they are considered stabilized, so no save. I think this will encourage some of that teamwork stuff I'm arguing for, plus it makes it more fair, because bad luck does happen.
So yeah, there's a lot there, but I think that I've summed up how healing should/could work.
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