Vl. Damage and Healing.
Although this chapter provides loose guidelines for required healing times and Difficulty Numbers related to the treatment of injuries, refs are strongly encouraged to modify these values heavily. The information here is based on the assumption that victims suffering injuries are normal humans, and that anyone treating injuries has a modern understanding of the human body, but no special medical equipment. Thus, victims who are not human will likely heal at different rates and require different treatments. A dragon should probably heal quickly, while a fey creature may require magic rather than medicine as treatment. Similarly, an alien healer may possess a device that can repair a torn artery in a quick flash of light, but a medieval chirurgeon (or even a 19th century field doctor) might treat a compound fracture by lopping off the damaged limb.
Since game worlds typically contain magic or technology either far superior or inferior to our own 20th century standards, as well as creatures and people with characteristics very different from our own, you should treat the numbers in this chapter as suggestions only. If your game contains wizards who can fully heal a dying character with a word, or futuristic medics with amazing healing equipment, then by all means give those healers excellent Advantage bonuses. On the other hand, an ancient tribesman who doesn't even know to wash his hands before treating a wound might do more harm than good, and should have a major Disadvantage to reflect that. Modify these rules to make them fit the reality of your world.
The Wound column of the Damage Effects Chart lists Handicaps, terms that players and refs can use to get an idea of how badly a body part is impaired by injuries. Characters receive the Handicap listed for the Damage Level they've suffered; record the Handicaps each body part receives separately. Handicaps cause characters to suffer disadvantages when they make skill rolls. The ref determines the level of disadvantage a Handicap causes, and while no specific penalties are associated with different Handicaps, there are some guidelines. Minor Handicaps will typically give a disadvantage penalty of Minimal to Small. Moderate Handicaps run roughly from Small to Sizable, and Major Handicaps usually result in Significant to Tremendous disadvantages. Disabling and Crippling Handicaps usually mean the affected body part can't be used at all. However, if you do allow a disabled or crippled body part to be used, the disadvantage should be at least Massive and possibly higher than the listed penalty of -15 for Overwhelming.
The Wound column also lists point increases. These are Handicap Points; they are used to measure the cumulative effect of multiple injuries, and each body part keeps track of Handicap Points separately. They can cause an Overall Handicap, which is not an actual injury but rather the effect of the location's total injuries. When Handicap Points are scored in an injury, add the listed number to that body part's Handicap Point Total. Every time a body part's Point Total increases, check the new Total against the character's Handicap Level Numbers; the character's Overall Handicap equals the Handicap Level that covers his current Total. When determining disadvantages from Handicaps, a body part suffers the effects of either the worst single Handicap or the Overall Handicap, whichever is worse.
Players whose characters are being affected by Handicaps need to let the ref know what level they are and which body parts they apply to. When assigning disadvantages to player rolls, the ref should consider the severity of any Handicaps and the likelihood that they would interfere with the intended action. He doesn't need to tell the player the exact penalty a character is suffering, since the character himself can't judge precisely how badly he'll be affected. However, the ref should give players a general sense of the impact of Handicaps, so that they can make intelligent and realistic decisions.
The Shock column on the Damage Effects chart lists Shock Point increases. The number listed for the Damage Level taken is added to the victim's Shock Total. For more serious wounds an additional effect is listed. A Deadly result means the character will continue to suffer increases to his Shock Total at the rate of about 1 an hour. Mortal wounds increase the Total by roughly 1 every minute, and Fatal wounds add 1 every 10 seconds or so (5 or 6 a minute). These increases may be higher or lower at the ref's discretion, depending on the activity level of the victim, the nature of the injury, and so on.
Whenever a character's Shock Total increases, whether as the result of a new injury or continuing damage from Deadly, Mortal, or Fatal results, the character must make a Stamina roll with the Shock Total as the Difficulty Number. If the roll is successful the character may function normally. If the roll fails, consult the Damage Roll Failure Chart. Find the amount by which the roll failed and apply the effect listed in the Shock column. Incapacitated characters are able to walk slowly and talk, but are unable to make skill rolls involving physical activity. Immobilized characters are aware of their surroundings and can talk, but are unable to move. Unconscious characters have passed out. Dead characters receive a +20 to all rolls (only kidding, they're really just dead).
If a character fails a Shock Total roll, then succeeds or fails by less at another (the next one required by an increase to his Total), the character is assumed to have shaken off the effects of the failed roll and can function normally, or at least suffer a lesser penalty. However, characters cannot choose to make additional rolls to reverse an earlier, unlucky roll. Shock Total rolls are only allowed when there is an increase or decrease in the Total.
Stun damage is handled similarly to Shock. The numbers listed in the Stun column of the Damage Effects chart are Stun Points, increases to a victim's Stun Total. Whenever a character's Stun Total is increased, the character must make a Resist Pain roll with the Stun Total as the Difficulty Number. Success allows the character to function normally. If the roll fails, find the amount by which it missed the DN on the Damage Roll Failure Chart and apply the results from the Stun column. Stunned characters suffer the listed penalty to all rolls they make. Unconscious characters have passed out.
Stun Totals are reduced by roughly 1 every 6 seconds (5 in 30 seconds, 10 in 1 minute). Whenever a character's Turn comes around in the Order of Initiative, reduce his Total by a suitable amount and allow another roll; if successful, the character is assumed to have refocused. If the new roll is a failure, apply the listed result, even if it means the character's status worsens. An exception applies to character's who suffered the "Unconscious 2d5 Minutes" result. They are knocked out for the indicated amount of time, then awaken. While unconscious their Stun Totals are not reduced; they awaken with the same Total they had when they passed out.
When a character is suffering the effects of a Deadly, Mortal, or Fatal injury, the wound needs to be stabilized. This means that someone has to provide enough basic first aid to keep the character from quickly dying. Stabilized wounds continue to cause damage but at a reduced rate. Wounds must be stabilized before any treatment to actually repair damage can begin.
To provide first aid, a character needs to have some sort of relevant skill, most likely a Biosystems skill. Other possibilities might include certain Techniques; basic military training, for example, includes instruction in the treatment of battlefield wounds and other common ailments. If a skill from a Talent other than Biosystems is used, however, a familiarity modifier should probably be applied. First aid attempts take anywhere from about 10 seconds to 1 minute, depending on the nature of the wound (torso and head wounds are the most difficult), the wound's severity, the skill of the practitioner, and the equipment available.
To stabilize a wound, the character providing treatment must roll with their skill against the DN's listed on the Shock Healing Chart, along with any modifiers the ref thinks necessary. Success indicates that the rate of continuing damage is reduced to +1 every 2 hours.
Should a character fail a stabilization roll he may continue to work on the patient. However, rolls made after a failure should suffer an increased DN. 2 to 5 points should be added onto subsequent rolls for each failed attempt, the exact number depending on the amount by which the failure missed the DN, the nature of the wound, and so on. Characters can't simply roll stabilization attempts until they get lucky.
Once a wound has been stabilized, the victim must remain still or it will begin adding Shock Points at a higher rate again. The exact rate at which such damage accumulates is determined by the ref, but shouldn't exceed the normal rate for the original injury. Consider the nature of the wound and how much the victim is being jostled about or attempting to move when deciding how much additional damage is taken. If an injured character exerts himself too much, the entire stabilization process might have to be performed again.
A person may only conduct first aid on one wound at a time. Once all wounds are stabilized, anyone attempting first aid can do little but comfort an injured person and keep them inactive.
Once a wound has been stabilized, someone still needs to fully stop the continuing damage before healing can begin. Stabilization just means that the rate at which damage increases has been temporarily slowed to a manageable level.
To actually repair a Deadly, Mortal, or Fatal wound more advanced medical care is needed. Depending on the game world and the character's circumstances this can mean cauterization with a hot poker, a magical incantation, or a team of doctors in a state of the art trauma center. While first aid would represent a medic using a bandage or tourniquet to stop blood loss, actual treatment of the wound would be emergency room doctors performing surgery to repair the torn artery causing the bleeding.
Treatment of a continuing damage wound cannot begin until the wound has been stabilized. Once stabilized, a character can attempt to repair damage. To do so the healer must make a roll using a relevant skill, probably one governed by Biosystems. The roll should be made against the same Difficulty Numbers that are used for first aid rolls. However, the standards for applying advantage/disadvantage mods based on healer skill, facilities, and equipment, should be much stricter. For example, a person who's taken one or two first aid classes could try to stabilize a Deadly wound with a simple pressure bandage and not suffer much of a disadvantage; he might even deserve a bonus. If the same character tried to actually repair the wound, though, without proper medical equipment, a large disadvantage would certainly be in order. The character should probably also face an unfamiliarity mod as well, since surgery isn't covered in your average first aid class. Although first aid and treatment use the same DN's, treatment is actually much more difficult.
If a treatment roll fails, allow the healer to continue making attempts with increasing DN's, as you do with first aid failures. When a treatment roll is successful, the wound will no longer cause continuing damage. The wound will still need time to heal, but unless the victim puts some substantial strain on his body he should recover normally. Characters who've been successfully treated should be allowed a bit more activity than those who are only stabilized, but it's still best for them to not move about or suffer much stress. If they're too active you might declare that they have torn open wounds and started the continuing damage process over again.
Shock Point Totals are reduced at the rate of 1 an hour, as long as the victim is sleeping or resting. If a character is being transported, is moving about, or is otherwise being disturbed, recovery should be cut to 1 every 2 or 3 hours, possibly less. Characters with Shock Points should focus on recuperation if it is at all possible.
A character who is suffering continuing damage does not recover any Shock Points. As long as a single Deadly, Mortal, or Fatal wound remains untreated, no reduction in the Total is made.
Once the Point Total has begun to drop, characters who have failed a Stamina roll against their Total may roll again to see if their condition improves. It the Total is still very high the player may wish to wait before rolling; he may have been very lucky to suffer an Unconscious result rather than dying, and another roll might prove less favorable. Or, if you feel like being generous, you might declare that a character whose Total is dropping simply can't suffer a worse result from the Damage Failure Chart than he already has.
For the most part, Handicaps heal themselves over time. However, for Major, Disabling, and Crippling Handicaps, a healer should roll to determine whether the damage will leave any permanent effects. Minor and Moderate Handicaps are assumed to cause no long term impairments.
Use the DN's listed on the Handicap Healing Chart for anyone treating such wounds. The ref should heavily modify these numbers to fit his world, even more so than with the treatment of Shock injuries; remember that they're based on a modern understanding of physiology but no special medical equipment. Take Disabling Handicaps as an example. In the modern world, if a leg or arm bone has suffered a simple fracture, doctors can easily set it, put on a cast, and heal the wound so that the limb functions as well as it did before the injury occurred. In the past, though, a broken extremity might heal incorrectly and cause the victim a lifetime of pain, or doctors might even choose to amputate the limb. The point here is that healing this sort of injury is greatly affected by the healing knowledge and equipment available. Refs should be prepared to set substantial advantages and disadvantages when healing Handicaps.
To treat the more severe Handicaps, the attending healer makes an appropriate skill roll, modified by the ref, against the DN's from the chart. Success indicates the wound will heal properly and not cause the victim any substantial problems. You might in the future tell a character that his old injuries ache when the weather gets cold or some other such descriptive touch, but actual penalties will not be applied. If the roll fails, that healer has done the best he can and may not try again (though another healer can make an attempt). Based on the nature of the injury, the healing techniques used, and the margin of failure, you might wish to choose a permanent disadvantage for the wound. This would represent bones and muscles that didn't knit together properly or other such unpleasantries, and could take the form of chronic pain, reduced range of motion, and so on.
In the case of Crippling injuries, a permanent disability is almost guaranteed. It might be a blinded eye, burst eardrum, severed limb, nerve damage, or any other nasty effect the ref finds appropriate for the wound. Refs are left to their own discretion when setting DN's for healing Crippling wounds; in most cases the best that can be hoped for is to minimize the impairment and allow the wound to heal as much as possible. For a mangled limb, this might mean saving as much flesh and bone as possible and preventing infection. Exceptions should be made if healers have access to truly amazing technological or mystical healing techniques.
When assigning permanent disabilities, allow the wound to heal; the body part will no longer have a Handicap Level, and Handicap Points will be recovered. However, make a note of the character's new disability and take it into account when setting future DN's. For example, a character missing a hand should have greater difficulty performing actions that usually require 2 hands. Similarly, a character who lost an eye would have trouble making Alertness rolls that involved peripheral vision, and his impaired depth perception would make using ranged weapons harder. Rather than assigning a single, permanent disadvantage, remember the impairment and consider it when rating the difficulty of future actions.
Note that a character's Overall Handicaps do not require treatment. They are the effect of other injuries, but are not wounds themselves. The next section covers reduction of Overall Handicaps.
The rules discussed so far have dealt with stopping Shock Point increases and repairing Handicaps so they won't cause permanent disabilities. Once those concerns have been taken care of, though, an injured body still needs to mend. Just because the doctor pulled bullets out of a character and stitched up that ugly knife wound doesn't mean the patient's ready to hit the streets. The time has come for some serious rest and recuperation.
That's where natural healing comes in. When characters are recovering from Handicaps and Shock wounds, they need to make a Health skill roll to see how quickly they're back on their feet. Such rolls are Accomplishment rolls; there is no Difficulty Number. The ref should apply any fitting advantages or disadvantages to the roll, to reflect the character's living conditions. Good food, lots of rest, and a nice warm bed will help a patient recover, while exposure to the elements, poor nutrition, physical mistreatment, or even stress will slow healing.
Once a character has made the roll, consult the Handicap or Shock Healing Chart, whichever is appropriate, to find the normal healing time. Based on the level of the character's Accomplishment, increase or reduce the listed times. If the patient has been healing for an amount of time greater than the modified time from the chart, the level of his Handicap or Shock wound will fall. The "Full" column lists the amount of time for a wound to be completely healed, and the "1 Level" column lists the time for a wound to improve by a single category, e.g. from Disabled to Major or from Fatal to Mortal.
When Handicaps are reduced in level, recalculate the body part's Handicap Points. That is, erase the previous Point Total, treat any new Handicap levels as though they were fresh injuries, and calculate a new Point Total. If the character is lucky this will result in a reduction of the Overall Handicap.
You'll notice that no numbers are listed for Crippling wounds. The amount of time needed to heal such injuries is left entirely to the ref's discretion. In some cases, healing might be quite rapid; a limb was severed, so you stitch it up and let the stump heal. There will obviously be a penalty forever after, but the wound itself won't take too long to recover. On the other hand, a Crippling result to the head might leave a character in a coma for months or years, or a broken back might cause paralysis. Since there's so much variety in recovery from injuries of this severity, choose your own required times that fit the wound and the level of realism you want in your campaign.
Keep in mind that the times listed on the chart are for normal human beings. For other species or characters with very unusual powers the times may vary dramatically. For characters who are human (or nearly human) but who somehow heal better than normal, an advantage will probably suffice.
Alternacy treats the role of the healer in two different ways. The first has already been discussed; putting an end to continuing Shock damage and working with severe Handicaps so that they heal correctly. This is considered treatment. Treatment (in Alternacy) occurs when a healer steps in and does what the body can't. For example, you can't wait for a punctured lung to heal itself; if you did, the patient would die before his body could even begin to repair the damage. Likewise, bones will knit together if they're given time, but without a healer's guidance they're liable to be deformed when they do.
While treatment is vital, healers are still useful when a body is on the mend. At this time, healers can take actions that help the body heal more efficiently than it can on it's own. Such actions can include monitoring a patient's nutrition, applying herbs or medicines that speed recovery, keeping wounds clean, or directing physical therapy. Unlike treatment, the body is now doing most of the work, but the healer is making recuperation easier.
Healers who are providing this kind of continuing care for patients may make assistance rolls with their relevant medical skill. As usual, the ref should apply advantage/disadvantage mods to represent the healer's technique and equipment. If any bonus is gained, it is applied to the patient's Health roll to determine healing time.
On the downside, failed rolls mean the healer has actually hurt the patient. At the least this will slow down the healing process. At worst, Automatic and Spectacular failures probably mean something has been done that may well threaten the patient's life. Details are left to the ref's imagination.
Since game worlds are often very different from the one we're familiar with, it's quite likely that characters will come into contact with truly amazing healing powers. This would include futuristic or alien devices and drugs, magical herbs and incantations, or miracles. Such forces have the potential to heal the body in ways that are impossible in our modern world.
If the person or device that is enhancing recuperation simply assists the body's natural processes, shaving some time off of what's normally required to heal, then the situation is treated as assisted healing. For major improvements, such as a hospital in your futuristic campaign that cuts healing times in half, you'll want to assign a large advantage to the healer's rolls. However, as long as the treatment is still assisting what the body would do anyway, it's considered assisted healing.
In extreme cases, the healer is actually forcing the body to heal at an accelerated rate, rather than just helping it along. A holy man who can wipe away all traces of a stab wound with a pass of his hand, or a tissue-regenerating cast that repairs broken bones overnight, would be examples of this type of healing. If your campaign includes such effects, you'll need to handle them differently than other types of healing.
Basically, all you need to do is decide what the healing agent is capable of and set a Difficulty Number for it's use. In the case of the regenerating cast, you would choose a DN to represent the user's ability to set the bone, put the cast on, and adjust the settings. Aside from setting the bone, this might be very easy; maybe the technology is so simple that the casts come with a sheet of instructions in first aid kits. If the roll is successful, the cast would achieve the desired effect.
Depending on the healing agent being used, rolls of this type might be treated a bit like Accomplishment Rolls. This is especially true when the agent does not always achieve the same result even when used properly. The holy man is a good example of this; his efforts may not help at all, or they may return the patient to perfect health in seconds. The cast, on the other hand, always increases tissue regeneration by a certain percent when used correctly.
In either case, treat your DN as a benchmark; beating it means that something good has happened, but exactly what depends on the healing agent. If the agent is like the cast, and automatically creates a certain effect, then success allows that effect to occur. If the agent has a range of possible good effects, as with the holy man, then determine the outcome through either the margin by which he succeeded or comparing the result of the roll to the Accomplishment levels on the Difficulty/Accomplishment Chart.
Interpretation of failed rolls is left to the ref's discretion. They might mean that nothing at all happens (the cast turns out to be broken) or that some undesirable effect occurs (the holy man accidentally tears the flesh more).