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Healing in the Field

Earning your character’s First Aid merit badge

Back in my B/X D&D days, we had a house rule that said when you got to zero hit points, you were knocked out and dying at the rate of 1hp per round, but you weren’t dead until you reached negative hit points equal to your Level + CON bonus. If someone could “bind your wounds” before that point, you’d stop losing hit points (continued "binding" could restore 1 negative hit point per round until you returned from the brink of death).

I wanted to incorporate that concept into Chimera, and kept thinking of what “binding your wounds,” really meant. From my Boy Scout days, that pretty much meant first aid: treating for shock, stopping bleeding, applying bandages, splints, slings, knowing how to handle an EpiPen, and occasionally sucking snake venom out of your buddy’s leg.

First aid is all about stablising a patient with immediate care until more comprehensive medical treatment can be provided. Not unlike what adventurers have to do: Regardless of your setting, “comprehensive medical treatment” is rarely available in the field. And this is where first aid and healing--as it’s interpreted in most RPGs--part ways.

I’m Not A Real Doctor...

At a basic level, first aid is temporary field treatment, while healing is permanent hospital treatment. Think of it this way: first aid is what Aragorn gives Frodo at Weathertop. Healing is what Elrond gives to Frodo at Rivendell. In other words, first aid is enough to make an injury bearable or keep a patient alive until healing can actually fix the damage.

How you simulate this in your game depends on how your game represents wounds. In Chimera, each wound you suffer imposes a cumulative, overall penalty of -1 (i.e., you take 3 wounds, you operate at -3). When you heal a wound, the penalty abates; when all your wounds are healed, the penalty goes away.

This approach lets you simulate first aid’s temporary effect by addressing the penalty, but it ignores the actual wound. In Chimera, then, a successful First Aid roll reduces a patient’s wound penalty by -1 for a number of hours equal to the first-aider’s level. If the wound isn’t actually healed within that time, the penalty returns.

If your system uses hit points, first aid attempts might restore 1hp per rank in the first aid skill, though it would last only 1 hour per level. Or something along those lines. Basically, you want minimal restoration for a limited duration--just enough to keep the character going until he can get proper treatment.

And proper treatment requires full-scale medical facilities: a field hospital, a monastery, a clinic, a doctor’s office, an emergency room, a hospital ship, maybe even or Bethesda Naval Medical Center. By extension, healing also requires more training than first aid, so while any character can “bind your wounds,” actual healing requires a professional.

...But I Play One on Friday Nights

This approach makes the healing profession stand out a bit more. A combat medic can apply a good amount of ditch medicine in the field, but proper healing requires the medical droid back on the dropship. Of course, this approach makes the party cleric (or anyone else with healing magic or medical tech) truly valuable, because you're basically saying that as long as PCs are in the field, any damage they sustain is more or less permanent until they return to their home base.

There’s also a reverse benefit, though, because now you can allow your campaign’s “non-healers” access to first aid without unbalancing their role. Fighters, rogues, and other physical types--regardless of setting--naturally possess rudimentary first aid knowledge, just by virtue of fixing the cuts, bruises, and sprains they receive as they train. Magic-users and scholars get first aid knowledge because of the broad scope of their learning--even though they may insist on using leeches in their ministrations. Priestly types get first aid skill for much the same reason, but now you can decouple them from the default role of “healer” (which makes sense if the cleric’s deity has nothing to do with healing or if the cleric’s alignment makes him stingy about who he heals with his spells).

Now that you’ve opened up first aid ability to all characters, you’re increasing party survivability (or, at least, you’re fending off the TPK because characters have more restorative flexibility). At the same time, you’re also increasing the worth and benefit of actual healing sources in the field (i.e., during the adventure): magical potions of healing, restorative gel-caps, remote surgery bots, Med-suits, a working bacta tank found in the mad scientist’s lair, all have vastly increased value.

If these are appealing options, I suggest you replace your system’s Heal skill with First Aid. You can go a step further by adding a Professional skill for Physicians. That way, your characters can perform first aid during an adventure with a First Aid roll, but full-on healing is accomplished by an actual doctor (with access to actual medical facilities).

What Else First Aid Can Do

While I’m on the subject, here are some things you can do with a successful First Aid skill roll:

  • Temporary Relief: Reduce patient’s wound penalty by -1 for 1 hour/level (if your system uses hit points, a successful First Aid roll restores 1hp/skill rank for 1 hour/level)
  • Neutralise Poison: Stave off the effects of venom for 1 round per level or skill rank
  • Revive: Awaken an unconscious character, or snap a stunned character out of his stupor
  • Refresh: Negate fatigue-related penalty by -1

Final Words

By separating first aid from actual healing, you end up providing more survivability options to PCs without unbalancing the game. The side benefits include making healing more valuable as a service and healers more important as practioners. While much of this appeals to my sense of realism, my own experience confirms that it’s highly playable.

It’s a lot to consider--is this something that would work in your game?

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  1. August 11th, 2010 at 22:59 | #1

    For me, First Aid is always one of those things that fires up the war between realism and ease of play. I definitely think that first aid should be used not to heal, but to stabilize or help them feel/operate better.

  2. August 11th, 2010 at 23:36 | #2

    @Tourq : I think it’s partially a system thing. First aid doesn’t work elegantly with hit point systems – it comes off as looking like a scaled down heal skill. On the other hand, it fits with Chimera, which uses penalties for wounds, fatigue, and failed spell-casting. However you pull it off, though, it really does make a difference–PCs are a lot more cautious, which is good if your campaign style downplays combat.

  3. August 12th, 2010 at 06:35 | #3

    In the Legend of Zelda RPG, which is based on the d20 system, we actually have two different “healing” skills – you have the Heal skill as it works in D&D, which is good for healing others and first aid. We also included a Heroism skill, which was pretty much like “self-Heal” based of of Constitution rather than Wisdom, and reflected the ability to tough it out through all those hard times. This was suitable for the epic/video-game realism of the system and setting that the Legend of Zelda RPG provides.

    It’s pretty much a case of system and setting, and this should be an option rather than a rule. The idea of it working with penalties rther than hitpoints is a good one – the d20 vitality/wounds distinction was fairly clean cut, but caused complications with the critical hit rules which could kill PCs outright, and thus ruin a game by bad luck.

  4. nextautumn
    August 12th, 2010 at 18:03 | #4

    I’ve been playing with these ideas in my b/x d&d campaign. My problem was, since b/x characters are so fragile, and my players are overly cautious to begin with, they were always – always – holding up in some inaccessible place or going all the way back to town to rest. Rest, rest, rest – it got old.

    So I decided that any character could get the benefits of a night’s rest (1d3 hps) by simply wrapping wounds, etc. (the first aid type stuff you mention) after each fight. Of course, the character had to have taken damage that fight, and he couldn’t get back more than he’d lost during that particular fight. Damage beyond what they can heal this way is considered more serious, requiring a cleric’s curative spells, a potion of healing or like means to alleviate. Simply resting for the night no longer restores hps in my game – though, if you don’t rest after a FULL day’s adventuring you will take fatigue related penalties. I just wanted to avoid characters resting after every *&@#$ fight.

    The idea derives from the abstract nature of D&D’s hps, the loss of which is not intended to always indicate an actual wound. Since the wounds that cannot be healed in this way require more serious measures, this keeps the game dangerous (some of the loss hangs around, impervious to rest) and makes real healing magic (a cleric’s or otherwise) even more valuable.

    Now if I could just figure something out for magic so that the party’s casters don’t always want to rest to regain spells…

  5. August 12th, 2010 at 20:17 | #5

    @nextautumn : Having some way to recover even a modicum of hit points after a fight–before the next encounter–was part of my motivation behind First Aid. But the abstract nature of hit points (as you mention) can complicate this somewhat. In your game, characters get a few hit points back. In Chimera, you alleviate the effect of damage by dealing with the penalty.

    I have to say that breaking away from hit points has opened up a lot of opportunities for realism, without sacrificing playability. Handling penalties for wounds, fatigue, and even spell failure separate from hit points makes a big difference.

    And I might suggest a solution for your spell-casting woes: check out the magic use variants I wrote up for my old B/X campaign.

  6. deimos3428
    August 16th, 2010 at 14:03 | #6

    Hmm, I’m not sure how “resting for the night” is all that different from “first-aiding after an encounter”, when you’re dealing with fictional time. (You could just as easily elect to *not* roll for random encounters for the night, as GM.)

    But I’ll admit I was never a fan of after-fight healing by non-clerics…maybe emergency healing in the sense of “you won’t die immediately”, but no recovery of lost functionality for those unskilled in healing.

  7. August 16th, 2010 at 15:15 | #7

    @deimos3428 : You hit an interesting point: the D&D tradition that mandates clerics as healers. Always been a sticky point with me, since the only association between clerics and medicine is a handful of cure spells. Seems to sell the cleric (or, more precisely, the cleric’s potential as a class) short. More broadly, the implication is that the only means of healing in D&D societies are miraculous cures or weeks of bedrest.

    In a multi-genre, realism-in-the-setting sense, I see First Aid as a stop-gap provision for any character who lacks a medical background. Doctors–real physicians–wouldn’t normally embark on adventures, and even if they did, they wouldn’t have the facilities to make full use of their skill. Realistically, a cleric wouldn’t be defined by his healing ability (unless he worshiped a god of healing), and even a combat medic–skilled as he may be–has only limited recourse in the field.

    So as a character option (i.e., a useful PC skill), First Aid provides some realistic balance. It’s a temporary measure, designed to address effects instead of cause. Though I’ll admit that capturing that temporary aspect is hard in a hit point system.

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