Prolonged Death Saving Throws (5e Variant Rule)
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In real life, when a dying creature is left unattended, their life can potentially hang in the balance for minutes on end, or even hours. However, the normal rules for death saving throws do not allow for this, with a maximum of 5 rounds (30 seconds) before the creature either dies or becomes stable. Not only this, but heavier hits will put one’s life in much greater danger, and any hit to an unconscious creature, no matter how close they are to the brink, can easily kill them instantly.
One must tread lightly when dealing with a dying creature. This goes for magic as well, as the creature’s body could resist the magic in its attempt to fight off foreign elements, putting a strain on the already gravely injured creature and making matters worse. Furthermore, that magic which is usually effective at keeping a creature away from the brink is not the most effective magic when saving a creature that’s already there. Players must be careful with their dying allies, even in what magic they use, lest they make things very inconvenient, or, at the very worst, endanger said ally’s life even further.
Death Saves in Stages
With the prolonged death saves option, death saving throws happen in stages, and stabilizing a creature with a medicine check or magic takes more than just an action. There are three stages of death saving throws: critical, at-risk, and near-stable, with near-stable being the closest to stability and critical being closest to death. In most situations, being reduced to 0 hit points will put a creature in the at-risk stage. However, there are certain situations which can put a creature in one of the other two stages. Succeeding three death saves will reset the death save counter and bring the creature one stage closer to stability, while failing three death saves will reset the counter and bring the creature one stage closer to death.
Other rules that are different from the normal rules for death saving throws: any healing effect that restores hit points less than the creature’s hit point maximum counts as one successful death saving throw per die normally rolled for the hit points gained, instead of restoring hit points. If an effect would restore hit points equaling or exceeding the creature’s hit point maximum, it instead becomes stable without the need to have its wounds tended to (see below). Applying a healing effect to a stable creature will cause it to regain those hit points and become conscious as long as none (except cantrips and healer’s kits) were used during instability. Additionally, rolling a 20 on a death saving throw counts as 2 successful death saving throws instead of restoring 1 hit point.
Saving a Creature from Death's Edge
If an ally succeeds on a DC 10 medicine check to stabilize a creature, the creature does not immediately become stable, but instead is temporarily held one stage closer to stability without resetting the death save counter. On a 15, the dying creature is held 2 stages closer, and on a 20, the creature is held 3 stages closer. If the ally stops touching the dying creature, or if the ally does anything else on its turn, the ally must make another medicine check, or the dying creature returns to its original stage of death saves. If this medicine check brings the creature to stability, the ally must continue keeping the creature stable for 3 rounds before they remain stable on their own. Additionally, the spare the dying cantrip, a healer’s kit or anything else that would normally cause instant stability, will not necessarily stabilize a creature, but bring it one stage closer to stability.
If a creature fails a third death saving throw as a result of a critical failure or taking damage from a critical hit, it dies immediately regardless of what stage it was on.
If a creature succeeds a third death saving throw as a result of a critical success or a hit-point restoring effect, it immediately stabilizes and regains one hit point (for a critical success) or the hit points corresponding to the effect (for a healing potion).
Upon becoming stable, a creature will take a certain amount of time to regain one hit point based on the stages they went through: 2d20 minutes for every time it entered the near-stable stage, 1d4 hours for each time it entered the at-risk stage, and 1d12 hours for each death saving throw it made while in the critical stage. During this time, the creature must have its wounds tended to within 10 minutes of becoming stable (a process that takes 10 minutes and a successful DC 10 medicine check), and must then be repeated once every 2d8 hours. If this does not happen in time, the creature becomes unstable again (starting in the at-risk stage), but only makes a death saving throw once every 10 minutes. Tending to the creature’s wounds during this time will stabilize it for another 2d8 hours, while if it becomes stable on its own, the creature only has 1 hour before becoming unstable again.
If a creature is brought back to consciousness during this time, its hit point maximum is halved for the remainder due to the need to recover from things such as blood loss or other trauma. If the creature does anything strenuous such as traveling faster than a slowed pace or fighting during this time, the remaining time is doubled. Its injuries still must be tended to during this time as stated above, but the creature has the option of tending to its on injuries without help.
Stages of Death Saving Throws
In the near-stable stage, the creature is very likely to survive on its own, and makes death saving throws with advantage. If a creature takes damage that does not initially reduce them to 0 hit points, but an additional effect from the damage source reduces them to 0, such as a monk’s quivering palm or the optional system shock rule, the creature starts out in this stage. Another way that a creature can start out in this stage is if the creature is reduced to 0 hit points by an attack, but the attacker specifies it as nonlethal damage.
This is the default stage of death saving throws, where the creature suffers wounds that could easily be either survivable or lethal. Usually, if a creature is reduced to 0 hit points by damage, it will start out in the at-risk stage. Death saving throws are rolled normally in this stage.
In the critical stage, the creature is very likely to die, with deep wounds and heavy bleeding. Death saving throws are made with disadvantage, while healing magic is likely to be ineffective, and possibly kill the creature even faster by disrupting the body’s attempts to save itself. If any effect befalls the creature that would normally cause it to regain hit points, it instead immediately has to make a number of death saving throws equal to the number that it would normally automatically succeed, without disadvantage, the exceptions to this rule being healing potions or if the effect would restore a number of hit points equal to or greater than the creature’s hit point maximum, in which case the same rules apply as with other stages. Once the effect happens, regardless of whether the save succeeds or fails, the creature can no longer be affected by healing magic or psionics until the next time it becomes stable.
A creature starts out in the critical stage if it is reduced to 0 hit points by a critical hit or by damage equal to or greater than half its hit point maximum.
Other Gameplay Options
If you are playing with the optional system shock mechanic, and a creature is brought into the critical stage by damage, roll a d10. On a 1, the creature immediately enters the near-stable stage.