Pathfinder serious injuries chart

A while ago I was running a Pathfinder game, and started thinking about death and injury in the game. I’ve always been a bit wary of the way D&D-alikes handle this, for several reasons.

The systems tend to combine several things that don’t quite add up: healing spells that can cure diseases, heal wounds and remove mental impairment; resurrection of the dead; and presentation of sickly, crippled and simply dead NPCs. With perfect healing magic, there’s very little basis for characters (PC or NPC) to acquire cool scars, interesting injuries and other characterful features. The hard-bitten pirate with the eyepatch might as well get a Remove Blindness spell and carry on as before. That’s a shame, because those are interesting additions to a character. “I was an adventurer, until a troll killed my friends and took my eye,” but there’s very little support for that in a system with hit-point damage and magical healing. Put simply, there’s no way to lose that eye except by DM fiat or player invention.

Also, it creates a situation where danger has quite binary consequences. It’s all-or-minimal at low levels, where healing dents your gold supply and resurrections are unaffordable; it’s very nearly nothing-or-nothing at higher levels, barring the handful of effects designed specifically to inflict permadeath. Foolish mistakes that get you mangled by trolls will have no lasting consequences, which means being hacked to within an inch of your life doesn’t feel very different from getting slightly scratched, so for low-level characters either you win or you die. Once characters can resurrect their party members, even death is an inconvenience rather than a serious issue. This binary win/die situation makes me a bit uneasy. I worry that either PCs will end up dying because they don’t take injuries seriously (why should they?), or I’ll end up being over-lenient on character deaths because I’m a softie, which also distorts the game.

In older editions of D&D there are hard limits on resurrection, and XP penalties as well. That prevents infinite resurrection, but doesn’t tackle injuries or offer much support for running a world with resurrection magic.

I also tend to be uneasy about resurrection magic, because it seems like making it make sense in game is quite tricky. This is especially true when it’s available to benevolent clerics and allied wizards: why aren’t they just resurrecting all the accident victims and murderees? What exactly do they need that money for? But of course, if you start doing that, you run into other problems.

Anyway, I ended up with the idea that injury rules might either help this, or be an interesting addition to the game, or just be fun to make. I never actually ended up using them, so I’ve no idea how well they work or whether they’re a faff, and it could certainly do with a few more ideas if anyone has any. But here they are, for your entertainment/inspiration/nitpicking.

The idea is that when a character would die by the Pathfinder (or D&D) rules, they instead roll on the chart below to determine the consequences of their injury. Most serious injuries are more stubborn than those incurred in the normal course of the game. These injuries cannot be healed by cure or heal spells, but require specialist magic: essentially it’s going to be down to questing of some kind. For those with a keen eye, this is very heavily inspired by Necromunda’s serious injury chart.

Roll a d100 on the following chart. If a character would be entirely or largely unaffected by a particular result, perhaps due to racial or class abilities, choose another. Some injuries may result in other situational bonuses or penalties not specified here, as the DM thinks appropriate. Bonuses and penalties should be applied with common sense; injury descriptions take priority over flat mechanical rules.

1X: Dead.
Can only be raised with an appropriate ritual.
2X: Head Wound
20	Anosmia	The character’s sense of smell and taste is impaired. They suffer a -4 penalty on any checks to detect tastes or smells, such as scenting an enemy or detecting poison, and their pleasure in eating or drinking is reduced. This may prevent them from gaining the full benefits of certain fine or magical foodstuffs. However, they also gain a +4 bonus to resist negative effects, such as the nauseating stench of a troglodyte.
21	Partial Deafness	The character takes a -2 to initiative, appropriate Perception rolls and -2 on ritual casting rolls.
22	Deafened	A deafened character cannot hear. They take a –4 penalty on initiative checks, automatically fail Perception checks based on sound, take a –4 penalty on opposed Perception checks, and have a 20% chance of spell failure when casting spells with verbal components. Characters who remain deafened for a long time grow accustomed to these drawbacks and can overcome some of them.
23	Sensitive Ear	The character becomes unusually sensitive to certain noises. They suffer a -2 on saving throws against effects with the [sonic] descriptor, and find loud noises in general uncomfortable and unsettling.
24	Blinded In One Eye	The character takes a -4 to Perception rolls based on vision, -2 to attack rolls and -1 to Armor Class. Choose an eye at random. A character blinded in both eyes becomes totally blinded, though may slowly overcome some of their impairments. If the same eye is rolled twice, reroll on the Head Wound chart.
25	Partial Vision	The character takes a -4 to appropriate Perception rolls, -2 to any other skills based on vision, and -2 to attack rolls. They read at half speed and can see half the normal maximum distance.
26	Light Sensitive	The character is blinded if they are exposed to bright light or take damage from spells with the [light] descriptor. They can make a Fortitude save (DC 12 + level) at the start of each round to recover. In ordinary daylight, they are uncomfortable unless their eyes are shaded or protected, and may become dazzled.
27	Hampered Speech	The character suffers a -2 on speech-based Bluff, Diplomacy, Intimidate and Perform checks, and has a failure percentage chance equal to the spell level when casting spells with a verbal component.
28	Light-Headed	The character is more vulnerable to dizziness and fainting. The character suffers a -2 penalty to Acrobatics checks to keep their balance, to Climb checks, and to saving throws against effects that cause unconsciousness, dazing or stunning.
29	Severe Headaches	The character suffers agonising headaches at times of stress. In any highly stressful situation (DM’s decision) they must pass a Fortitude save (DC 5 + level) or suffer a -2 penalty on attack rolls and skill checks until the situation passes. Pain-suppressing magic, such as delay pain, can alleviate the effects.
3X: Emotional trauma
30-31	Nightmares	The character has regular nightmares, and may scream or behave oddly in their sleep. A character that does not sleep may have flashbacks instead during periods of rest. The character suffers a -4 penalty against any effects that manipulate their dreams (positive or negative).
32-33	Phobia	The character has intense fear of a particular situation, creature or object related to their injury. This might impose a situational penalty on morale, e.g. counting as shaken while the trigger is present; sudden unexpected exposure might make them flee or freeze. The phobia might manifest as flight, violent self-defence, freezing or any other suitable response.
34-35	Revulsion	The character finds a particular item or substance disgusting or hateful. They are distracted in the presence of the trigger object, and will avoid it where possible. A Will save may be necessary to interact with it (DC 12 + level).
36-37	Hatred	The character hates a particular type of creature, defined by the GM (anything from “orcs” to “Bone Islanders” to “elderly male elves with long beards”). The character suffers a -4 penalty on Diplomacy checks towards the target creatures, preferentially targets them in combat (other things being equal), and is likely to misattribute motives or intentions. They may need a Will save to break off an attack or hostile confrontation (DC 12 + level or as DM determines). Hiding their hostility is a matter of roleplaying and possibly Bluff.
38-39	Personality change	The character’s personality changes, either as a response to the near-death event, or due to an injury. They might become more nervous, bitter, irritable, more cautious; they might gain behavioural quirks appropriate to their injury, such as obsessively checking for traps, or always carrying a backup weapon.
4X: Lingering Injury
40-42	Aches and Pains	The character’s ability to withstand hardship is reduced. The character is treated as having 1 permanent point of nonlethal damage per character level. This damage does not heal from normal healing, nor from healing magic.
43-45	Weariness	The character is quickly tired by strenuous effort. They suffer a -4 penalty to skill and ability checks made to avoid nonlethal damage or continue strenuous activities (See the Endurance feat). They may need to make checks for physical activities that wouldn’t normally risk fatigue (such as significant climbs, or walking long distances with a heavy load).
46-47	Low Pain Threshold	The character is unusually vulnerable to pain, suffering a -4 penalty on any effect that causes pain.
48-49	Old Battle Wound	Though mostly healed, the injury flares up at odd moments. If the character rolls a 10 for any physical skill check (DM's definition), they immediately suffer the effects of a pain strike cast by a wizard of their level (save applies).
5X: Scarring
50-52	Restrictive Scars	The character has scar tissue, badly-mended bones or damaged nerves that limit their movement. They suffer a -2 to Athletics and Acrobatics checks.
53-55	Impressive Scars	The character has an obvious scar that makes them appear tough or dangerous. They gain situational bonuses or penalties to social skills (usually +4/-4), depending on those involved.
56-58	Horrible Scars	The character has an obvious and disturbing scar. They gain situational bonuses or penalties to social skills (usually +4/-4), depending on those involved.
59	Calloused	The character has reduced sensitivity in a body part (select at random) due to dense scar tissue, but is less sensitive to pain. Apply this ability as appropriate, with a typical -4/+4 modifier. For example, a character with calloused hands might struggle with lockpicking, but be able to shrug off heat long enough to drag something out of a fireplace, or climb a thorny vine without rolling to see if they can maintain their grip. This ability doesn’t necessarily prevent hit point damage, it just suppresses pain.
6X: Leg wound (select a leg at random)
60-61	Missing Leg	The leg is severed or rendered entirely useless. The character can crawl, or walk at -5 speed with support from allies or a crutch. With practice, they can learn to walk on crutches at full speed or run at double speed (speed-and-a-half in heavy armour) but cannot use the crutch arm – which is usually the opposite arm. With an artificial leg and some practice, they can treat this as a Wounded Leg (see below).
62-63	Wounded Leg	The character’s leg is painful and has reduced mobility. They suffer a -4 penalty to Acrobatics and Athletics checks involving the legs. They run at double speed (speed-and-a-half in heavy armour).
64-65	Slow Movement	The character’s movements are slower and more awkward than usual. The character suffers a -5 penalty to Speed.
66-67	Weak Leg	The character's balance and carrying capacity is hampered by a weakened leg.They suffer a -2 penalty on checks to avoid falling prone or being moved, and when attempting to bullrush opponents. Their weight thresholds are calculated on three-quarters of their Strength.
68-69	Limp	The character moves with a distinctive limp and struggles with obstacles. Their overland movement is calculated with a -5 Speed penalty, and they treat difficult terrain as x3 rather than x4.
7X: Arm wound (select an arm at random)
70-71	Missing Arm	The arm is severed or rendered useless. The character may no longer use that arm to hold or manipulate items. In addition, they suffer a -4 penalty to most Dexterity- and Strength-based checks using the arms, including combat manoeuvres where appropriate.
72-73	Lost Fingers	The character loses 1d3 fingers from the chosen hand. The character suffers a -2 penalty to most Dexterity- and Strength-based skill checks using the hands, and finds it hard to hold or grasp objects. They suffer a -2 penalty on attack and damage rolls using that hand.
74-75	Wounded Arm	The character’s arm is weak or difficult to control. The character suffers a -4 penalty to most Acrobatics and Athletics checks involving the arms, and a -2 penalty on melee attack and damage rolls using that arm. They may suffer other appropriate disadvantages.
76-77	Shakes	The character’s movements are shaky or clumsy. They suffer a -2 penalty to most Dexterity- and Strength-based checks using the hands.
78-79	Muscle Lock	The character's hand muscles are damaged, leaving them strong but barely mobile. The character can hold items, but must force their fingers open and closed using their other hand: for example, they can use their left hand to grip a bow in their right, then fire left-handed. They can't pick up most items, or use the hand for any task requiring manual dexterity; this imposes a -2 penalty on tasks such as grappling, lockpicking, playing the lute or forgery because they must rely on a single hand. Tasks such as climbing are very difficult (-4 penalty). Spells with somatic components may suffer a failure percentage chance equal to the spell's level (DM's decision per spell). The character can still attack using that hand, suffering a -2 penalty on ranged and melee attacks.
8X: Intellectual trauma
80-81	Memory Loss	The character struggles to recall and use information. They suffer a -4 penalty to any checks requiring recall of information, most importantly Knowledge checks. They may forget names and messages, or get lost easily. Deciding the parameters of a character’s memory loss is a matter for negotiation.
82-83	Attention Deficit	The character struggles to focus on a task. They suffer a -2 penalty to Concentration checks. In addition, any time they need to spend more than a few minutes on the same task, they are liable to become distracted and a Will save may be called for.
84-85	Disjointed	The character’s intellect is unimpaired, but they struggle to marshal arguments or arrange ideas in a logical order. They suffer a -4 penalty to Diplomacy checks, as well as any attempts to explain or discuss complicated topics.
86-87	Lightminded	The character’s resolve weakens, leaving them inclined to stare at lights and easily lulled by soft voices. The character suffers a -4 penalty against fascination effects.
88-89	Befuddled	The character becomes unusually prone to psychotic episodes. They suffer a -2 penalty on confusion effects. Narratively, the character may suffer from mild panic at stressful moments, or suffer occasional hallucinations.
9X: Complications
90-92	Liver Damage	The character’s ability to handle toxins is reduced, leaving them unusually susceptible to poisons of all kinds. The character suffers a -4 penalty on all saving throws against poison effects, including alcohol and other drugs.
93-94	Lung Damage	The character's lung capacity is reduced, making it harder to breathe and leaving them more susceptible to airborne hazards. The character suffers a -4 penalty on saving throws against gases of any kind, or any roll relating to controlling their breath, including appropriate Perform checks.
95-97	Weak Stomach	The character is unusually sensitive, suffering a -4 penalty against any effect that causes sickening or nausea. They are likely to find certain foods, perfumes and other strong scents unpleasant.
98-99	Sleep Disorder	Lingering pain, emotional trauma or metabolic damage disrupts the character's sleeping patterns. They may struggle to stay awake for long periods, or find it difficult to sleep. They suffer a -4 penalty on any effect that effects sleep in any way.
0X: Special
00-01	Anomaly	Something very strange happens: the character is saved by an alternate-universe duplicate; an apparently-inert bracelet erupts into a miniature golem that absorbs the killing blow; a spirit or deity revives the character with a message, offers a bargain, or places a geas on the character; the character becomes a ghost, shade or other intelligent undead.
02-03	Wandering Soul	The character's spirit goes astray and must be brought back before they can reawaken.
04-05	Soul Infestation	Evil influences or psychic predators latch onto the character as they lie unconscious. It may take some time for their presence to be noticed, even once the character reawakens. Use any suitable monster, or invent your own.
06-07	Spiritual Acquaintance	Drifting in unconsciousness, the character encounters wandering spirits that may try to steal their body, become parasitic, befriend the character etc.
08-09	Awakening	The character develops unexpected abilities, but usually at a cost... for example, they might gain a minor spell-like ability or a lesser feat, but lose a point of statistic. They might begin to speak visions, without knowing their meaning. This may be a good opportunity to introduce features from another setting in a very limited way.