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This is an outline for a proposed damage system that will encourage the injured to remain at rest without completely barring them from meaningful or interesting RP. It is designed to require as little GM interaction as possible. Note that there are few "hard limitations" on this system. The player will never be forced to rest and recuperate, though they will be forced to suffer the consequences for said actions. For purposes of clarity I will use hard figures though a degree of randomization may be more appropriate, as may variations based on type of injury received.

It will require some work to implement, I believe. The biggest change will probably be a distinction between "home," "outpost," and "field" areas, "home" indicating that a particular room is safe and can be traversed with a minimum of effort, "outpost" that it would be stressful for an injured person to get around but that it is generally clean and safe, and "field" representing untamed wilds and locations that may be dangerous even for the healthy. The interiors of houses (including non-bedroom areas) would be marked as "home," as well as treatment areas like a doctor's office or bath. "Outpost" would be the rest of the Outpost, where exposure to the sun and elements complicate healing. "Field" conditions would be actively dangerous for the injured and may exacerbate their condition. These distinctions could be nothing more than flags on rooms or room parents.

First, when a severe injury is received the system will actually recognize it as two types of damage. The first is the temporary damage, which is visible to the player, and the second is permanent damage, which is not. When the injury is first received the permanent damage should be much lower than the temporary damage as it is very difficult - and in some cases impossible - to reduce permanent damage (that being what makes it permanent). For the purposes of example, let's say that permanent damage defaults to 50% of temporary damage, to account for natural resistances and recovery. For instance:

Assarka is stepped on by a big fat elephant. She takes 50 temporary damage and 25 permanent damage.

If she does not receive medical treatment, she will have a significant permanent injury. At this stage, medical treatment is treated like "first aid," and has a great impact on her chances for recovery, say to the tune of 5 points per level, including 0. Therefore it would require a level 4 healer to avert all permanent damage, which is pretty reasonable seeing as an elephant has stomped her. Future medical treatment may be able to further reduce the damage, but only if the medic is more skilled than the one who administered first aid and even then at a reduced rate.

If Assarka does not receive any treatment within the first 2 hours (real time), we will consider the wound to be untreated. We might consider a mechanic for a worsening of her condition due to blood loss if she remains in an "outpost" or "field" area, or infection from the "field." In order to keep players from gaming the system, I would recommend we make it impossible to train skills in the field, so they can't suddenly decide that they've learned a single point in first aid due to divine inspiration.

Let's assume that Assarka has a level 2 healer with her. That healer treats her injuries immediately and brings her down to 15 permanent damage.

At this point, it is essential that Assarka rest. She is in the field, and therefore cannot effectively rest where she stands. While she is in a field area she will lose 10+5n energy every hour (real time), where n is the number of hours she has gone without effectively resting (more on that later). She will also gain 1 permanent damage, up to a maximum of 100% of her temporary damage (for Assarka, that is 50).

Hour 0: 10 energy.
Hour 1: 15 energy.
Hour 2: 20 energy.

And so on. If Assarka hits 0 energy she will fall unconscious and gain another 5 permanent damage for straining herself beyond her breaking point. Note that eventually she will be losing more energy per hour than her maximum. At that point she will be considered incapacitated and either must be transported home or limp home between bouts of unconsciousness. Note: this system may require some tweaking or re-evaluation as it is heavily dependent upon pose speed, and discourages longer, more thoughtful poses. We may also consider a lesser penalty for "outpost" areas. I won't get in to blood loss/infection mechanics as that seems relatively easy to tack on to the framework as described.

For our example, let's say it takes 2 hours real-time to get Assarka somewhere where she can rest. That's an additional 2 points of permanent damage, bringing her to 17.

Since it is not always possible or practical to bring someone all the way back to town when they're injured and we shouldn't punish people for wanting to stay with their group and scene, I propose a deployable "camp" item that temporarily turns a room into a "home" area. The item would be expensive, would require a degree of expertise to set up and break down, and would require real time to do so as we do not want people laying down a path of camps so they can get home without risking further injury (although the image of Assarka hopping home in a sleeping bag is hilarious).

When Assarka is in a "home" square there are no further penalties, assuming she doesn't get into another fight or use her dancing skill or anything else where she really ought to know better. At this point she is considered to be treated and resting, and so long as she stays at home and behaves she will sustain only 17 points of permanent damage from a 50-point injury. If she leaves the "home" area she will continue to tire and exacerbate her injuries again for the duration of her excursion. Once her temporary damage is lower than her permanent damage she will be considered "stable" and can move about as she pleases without risking a worse permanent injury.

But what does 17 points mean? I'll use Uthio as an example for a head injury because I like to pick on him. :D

0-10: Permanent scarring. May have an effect on attraction, based on location.
11-30: Minor internal scarring that may render an area slightly sensitive but will not significantly impair function. For instance, a sore joint that aches when it's about to rain.
31-50: Significant permanent injury resulting in some loss of use. A limb might be stiff enough to reduce mobility, a hand's grip may weaken, the character may start to walk with a limb, and Uthio might forget where he put his keys. 1 point penalty to an associated attribute.
51-70: Moderate permanent injury resulting in additional loss of function. An arm would be too stiff to lift above the chest, a hand might lose dexterity and coordination and the limp would be so severe as to require a cane. Uthio has trouble focusing. Still 1 point penalty, but with different RP implications.
71-90: Severe permanent injury. The limb becomes useless due to scarring and nerve damage. Character may require crutches to move around. Uthio may lose fine motor skills (such as speech) and forget things. 2 point penalty.
91-100: Amputation. The limb is either severed outright or has become so useless and painful that it is irreparable and must be removed to avoid infection. Uthio is unable to care for himself and may lose awareness of his surroundings. 2-3 point penalty, depending on injury.
100+: Mortal wound. The character will not recover. They will die soon and there is nothing anyone can do to stop it.

At 17, Assarka will have a new scar and an old complaint that will serve as a reminder as to why one should avoid getting stepped on by elephants. She will suffer no permanent penalties for her experience (and gains a new ability: sense weather!).

Note that this example does not account for medicinal treatment such as painkillers, or cover what happens if Assarka continues to fight despite her injury, or if she is injured in the same spot twice. I think there should be a penalty if her arm is fractured but she continues to use it to fight, or if she walks on a broken leg (maybe some permanent damage per room she moves to on her own?). Again, this shouldn't prevent Assarka from defending herself or getting herself home, it should simply make it much preferable that she have someone else defend her and carry her home.

…Which is really not that unreasonable to ask of someone who has just been crushed by an elephant. :)

It also doesn't consider what happens when someone with a temporary injury refuses to rest and recuperate, though it could easily be adapted to that: stressing a temporary injury could cause it to worsen or heal improperly, resulting in permanent damage.