Injury System

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 * Getting Injured *
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Whenever an attack drops an opponent to 0 hp, inflicts 50 or more damage with a single hit (a massive damage attack), or is a critical hit with a weapon for which the wielder has the Maiming Critical feat (see below), the target must make a Fort save against a DC dependent on the damage dealt or suffer an injury. If the attack dealt less than 50 damage, the Fort save DC is equal to 1/2 the damage dealt. If the attack dealt 50 or more damage, the DC is instead equal to 11 + 1/5 the damage dealt (round down). If an attack dealing 50 or more damage drops an opponent to 0 hp, add 4 to the Fort save DC to resist injury. If a critical hit with a weapon for which the wielder has the Maiming Critical feat deals 50 or more damage, increase the Fort save DC to resist injury by twice the weapon's critical multiplier (as noted in the feat description below).
Any effect that protects a creature against critical hits offers the same protection against injuries; however, at the GM's discretion, certain creatures that are immune to critical hits may still be susceptible to specific injuries as appropriate for their anatomy. For example, undead, constructs, and other creatures with clearly defined limbs can still have their limbs mangled or cut off, despite being immune to most other injuries and to critical hits.

If the save fails, roll 1d20 + damage inflicted if the attack dealt less than 50 damage, or 1d20 + 45 + 1/10 damage inflicted (round down) if the attack dealt 50 or more damage, and consult the following table. The attacker may choose any injury up to the result rolled. If the attacker selects an injury corresponding to a result lower than the one rolled, and that injury involves a roll for affecting a random body part, the attacker may select which body part to affect instead.
	Result	Injury (brief summary; see below for complete mechanics)
	<36	Bleeding wound (1 damage/rd, or 1d4 if subject takes strenuous action)
	36-40	Battered limb (-2 to checks involving the limb, and reduce speed if injured leg)
	41-45	Vicious wound (Reduce maximum hp)
	46-50	Head trauma (Lose use of an eye, or mangling of face impairs speech, or concussion)
	51-55	Mangled limb (Lose use of the limb, reduce speed if injured leg)
	56-60	Internal rupture (-3 to highest of Str, Dex, or Con)
	61-65	Brain trauma (-3 to highest of Int, Wis, or Cha)
	66+	Grave wound (staggered, and once/hr make Fort save or lose 1 Con)

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 * Multiple Injuries *
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Unless otherwise noted, if a character already suffering from an injury sustains another injury of the same type, the injury's severity worsens and any penalties imposed are cumulative. For example, a character suffering from a concussion may sustain a second concussion, increasing the total penalty from the injury to -4. Track healing of cumulative injuries separately.

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 * Healing Injuries *
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Unless otherwise noted, injuries require 1d4 months to heal. Diagnosing the time needed for an injury to heal requires a DC 15 Heal check. A successful Heal check (DC 20) to treat the injury can reduce the time needed by 1 month, plus an additional week for every 10 points by which the check exceeds the DC. This check takes 2 hours, requires the use of a healer's kit or similar set of tools, and can only be done once per day. Furthermore, the patient must take no strenuous action for 24 hours after the Heal check for the treatment to take properly. A patient may benefit from treatment in this manner on consecutive days; receiving further treatment, whether for the same injury or a different one, does not count as "strenuous action" for determining whether a previous day's treatment will take. If a Heal check would reduce the time needed to less than 1 month, healing takes 2 weeks instead. Healing magic generally does not affect healing of these injuries, with the exception of the Regenerate spell (which will heal any and all such injuries the recipient may have) and other exceptions as noted in the specific injury descriptions. Even with magic, these injuries nearly always leave noticeable scarring; the only exception is if the subject receives a Regenerate spell.

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 * Compensating for Injured Arms *
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A character with an injured arm may use their off hand instead for tasks that require only one hand, but unless they have the Two-Weapon Fighting feat, doing so imposes a -4 penalty to attack rolls and skill checks using that arm, and only half the character's Str bonus is applied to melee and thrown weapon damage rolls. Characters with the Two-Weapon Fighting feat are ambidextrous, and so take no penalties when using their off hand instead of their main hand.

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 * Injuries on Critical Hits *
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A character with the proper feat may inflict injuries on a critical hit:
 Maiming Critical [Fighter]
	Prereqs: Improved Critical, BAB +11
	Benefit: Whenever you score a critical hit with a weapon for which you have the Improved Critical feat, you also have a chance of inflicting an injury, even if the attack deals less than 50 damage. If your critical hit also deals 50 damage or more, the save DC to avoid injury is increased by an amount equal to twice the weapon's critical damage multiplier.

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 * Nonhumanoid Anatomies *
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The injury descriptions and mechanics assume a human-shaped body plan, with two arms, two legs, a head, and a torso. Creatures with a different body shape may require adjustments. A creature is not subject to injuries affecting a body part it does not have; for example, a snake cannot have a broken leg. If lack of the appropriate body parts would render an entire tier on the injury table invalid for that creature, extend the next lower tier to include that tier's range. If an injury result involves rolling for a body part, adjust the roll to exclude body parts the creature lacks. For example, a djinni, which lacks legs but has arms, would have a 50% chance of each arm being affected by a battered or mangled limb injury, rather than the usual 25% chance for each arm and each leg.
Similarly, creatures with extra appendages should adjust the limb injury tables to account for these. For example, a dragon would, in addition to two "legs" (the hind limbs, which are used primarily for movement) and two "arms" (the front claws, which are additionally used for manipulation and attack), include chances of injury to the tail (note that tail injuries should only be included if the creature uses its tail for movement, manipulation, or combat; a dragon's tail would be a viable injury target, since it has a tail slap attack, but a tiger's tail would not) and each wing (with wing injuries treated similarly to leg injuries, but applied to fly speeds instead of land speeds).
Creatures might also have only a single appendage of a certain type or a single appendage that serves the function of a pair of human limbs. For example, salamanders have a single tail which functions both as a means of locomotion and as a natural weapon. Thus, for a salamander, there would be three possible results for a limb injury -- one for each arm, and one for the tail, each with a 1/3 chance of being rolled. An injury to the tail would be treated as a leg injury, applying penalties to speed as well as the salamander's tail slap, improved grab, and constrict.

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 * Full Injury Descriptions *
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Bleeding wound
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>The wound bleeds profusely, dealing ongoing damage.

Subject takes 1 damage each round, or 1d4 damage if they take any strenuous action in the round. Bleeding can be stopped with a Heal check (DC = the Fort save DC for the attack inflicting this condition; full-round action, provokes AoO), restoring an amount of hp equal to the damage dealt by the attack inflicting this condition, or after 5 minutes.
If the Fort save to resist injury was failed by 10 or more, the bleeding damage is doubled.


Battered limb
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>One of your limbs takes a nasty hit, inflicting nasty bruising, cuts, spraining, or possibly even a partial fracture. Though still intact, it's not quite working at full capacity anymore.

Roll 1d4. 1: Right arm; 2: Left arm; 3: Left leg; 4: Right leg
If leg, reduce base land speed 10 ft and take -2 to any rolls involving use of the leg (including damage rolls for unarmed strikes). Injuries to multiple legs cannot reduce a creature's base land speed to less than 10 ft.
If arm, take -2 to any rolls involving use of the arm (including damage rolls).
If the Fort save to resist injury was failed by 10 or more, the penalties to rolls are doubled and (for leg injury) speed is halved instead of reduced by 10 ft.
A Restoration, Heal, or Greater Restoration spell will heal this injury.


Vicious wound
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>You suffer a truly brutal wound that will be very difficult to heal. Examples might include cracked ribs, a deep puncture wound, or severe lacerations.

The subject's max hp is reduced by an amount equal to the damage dealt by the attack that inflicted this injury. The subject's max hp total returns to normal at a rate of 1 hp per day, or 2 per day with complete bed rest; providing long term care with the Heal skill doubles this rate. A Restoration spell restores an amount of max hp total equal to the subject's Con score or the spell's caster level (whichever is higher). A Heal spell, if the amount of hit points it would restore exceeds the subject's current maximum as modified by this injury, removes the penalty at a rate of 1 hit point per two that the spell would restore (essentially, spending 1 hit point of healing to reduce the penalty, then another to restore the newly available hit point). Greater Restoration and Regenerate spells heal this injury entirely.
If the Fort save to resist injury was failed by 10 or more, this condition additionally halves the rate of all healing, both natural and magical. This also halves the rate at which Heal spell restores the subject's max HP total (meaning it takes 4 points of extra healing to restore 1 point of max HP).


Head trauma
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>You suffer a nasty wound to the head. It might damage an eye, mutilate your face, or rattle your brains substantially.

Roll 1d6. 1: Blinded right eye; 2: Blinded left eye; 3-4: Mangled face; 5-6: Concussion
If blinded eye, -2 to Spot, Search, and Ref saves, and enemies gain double benefits from flanking. If both eyes lost, character is blinded.
If mangled face, -2 to all Cha-based checks involving speech or vocalization, and 10% chance of botching spells with verbal components.
If concussion, subject takes -2 to all rolls (including weapon damage).
If the Fort save to resist injury was failed by 10 or more, the penalties from a mangled face (including the spell failure chance) or concussion results are doubled.
A blinded eye result is normally a temporary injury; however, if the Fort save to resist injury was failed by 10 or more -or- if an already-injured eye is wounded again, the eye is lost beyond recovery. Only a Regenerate spell can restore a lost eye.
A Greater Restoration or Heal spell heals a concussion, mangled face, or temporarily blinded eye, but cannot restore a lost eye.


Mangled limb
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>Your limb is broken, possibly in several places. If you even have a limb left at all...

Roll 1d4. 1: Right arm; 2: Left arm; 3: Left leg; 4: Right leg
For leg, reduce base land speed by 2/3 (rounded up). Subject takes -10 to all checks involving use of the legs, and can't run or charge. Unlike for a battered limb, mangling of both legs may completely immobilize a creature (though it may still be able to crawl by pulling itself along the ground with its arms).
For arm, the arm can't be used.
A mangled limb can only be restored by natural healing, Greater Restoration, or Regenerate.
If the Fort save to resist injury was failed by 10 or more, the limb is lost entirely. It can only be restored by a Regenerate spell.

Internal rupture
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>You suffer a grievous wound that severely impairs your functioning, seriously damaging one or more internal organs, and probably cracking a few ribs along the way.

The subject suffers a -3 penalty to the higher of Str, Dex, or Con until this injury is healed. This is a penalty, not ability damage or ability drain.
If the Fort save to resist injury was failed by 10 or more, the penalty applies to all 3 of the listed ability scores instead of just 1.
This injury can only be healed by a Greater Restoration or Regenerate spell.

Brain trauma
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>MAn that het pudy haerd. Brain no wurks zo gud...

The subject suffers a -3 penalty to the higher of Int, Wis, or Cha until this injury is healed. This is a penalty, not ability damage or ability drain.
If the Fort save to resist injury was failed by 10 or more, the penalty applies to all 3 of the listed ability scores instead of just 1.
This injury can only be healed by a Greater Restoration or Regenerate spell.

Grave wound
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>You suffer a wound of such grievous severity that, without treatment and a little luck, could well mean your days are numbered. And even if you survive, you might never be the same again.

Once per hour, the subject must make a DC 15 Fort save or lose 1 point of Con score. This is not ability damage or drain, but rather permanent loss. Additionally, while suffering this injury, the subject is staggered (can take only a single move action or standard action per turn).
If the Fort save to resist injury was failed by 10 or more, the DC to resist Con loss increases to 20, and the subject is nauseated instead of staggered (can take only a single move action each turn).
This injury can only be healed naturally or using the Regenerate spell.
Lost Con score points can be regained with a Greater Restoration spell (which restores all lost points), or with a DC 40 Heal check to treat the character during a full day of complete bed rest (which restores 1 point per day).