Death Saves Revived

When D&D went to 5th Edition, they dropped the notion of negative hit points and came up with a new system called “death saving throws.”

Death Save Mechanics

Under this system, when you reach 0 HP, you fall unconscious and you begin making “death saving throws.” Each death save is a DC 10 check (no modifiers). It’s set up in a best-of-5 system. So, if you get 3 successes, you live; if you get 3 failures, you die. A creature who lives is stable at 0 hit points and needs time to recover. There’s an interesting little mechanic that instantly revives you with 1 HP when you roll a 20, and an opposite mechanic that gives you two death saves when you roll a 1. If you get hit, you lose 1 death save; criticals count as 2 hits.

Death Saving Throws

There was also a set of rules in Tomb of Annihilation called “Meat Grinder Mode” that set the death save DC to 15. This drops your survival odds from 60% to 26%!

Meat Grinder

Without getting into the minutiae, I submit that this is an improved system over negative HP. But, that doesn’t mean it’s perfect. What are some places we could improve the death saves system?

Being Unconscious

Being unconscious sucks in 5th Edition. It imposes a host of debilitating effects that render your character exceptionally vulnerable and useless during your turn (except for the opportunity to make a death save).

Unconscious Condition

Being unconscious leaves you prone, which is a mixed bag of mostly bad tricks.

Prone Condition

Being unconscious also imparts the incapacitated condition, which prevents you from taking actions or reactions.

Incapacitated Condition

These effects combine to create a system that is not very narratively satisfying on either side of the blade.

The Fallen

From the perspective of the fallen creature, they have been taken out of the game. They need to wait around for their turn to come around, and then all they can do is roll and pass. Even if they stabilize at 0 HP, they cannot make any difference in combat.

It would be more narratively satisfying if they could do something, even in a limited capacity. Crawl the last 5 feet towards the Big Red Button, utter your dying words, warn your allies, etc.

This would also give the baddies a reason to target fallen PCs, instead of forcing the DM to make the tough choice between breaking narrative to spare your character or being ruthless. The latter often feels like it’s being done by the DM and not the forces of evil.

Note: While I know not all foes will target a downed PC, it’s a reasonable tactic for any intelligent creature in a world with ubiquitous healing. To test this theory, add death saves and healing word to your monster stat blocks and see how the players respond. For better monster tactics, check out Keith Ammann’s work, The Monsters Know What They’re Doing.

The Coup de Grâce

The coup de grâce mechanic is a little odd, due to the interaction of a few rules:

  • You still need to roll to hit a lifeless creature.
  • But, you deal a critical hit when you do it.
  • Close attacks against you are made with advantage.
  • But, attacks at range are made normally. They would be made at disadvantage because you’re prone; they would be made at advantage because you can’t see.

This doesn’t fit with the way most people think this mechanic should be handled. In fact, less than 19% of players think that attacking an unconscious creature should follow this system:

Attacking an Unconscious Creature

Instead of attacking how the unconscious condition works, perhaps we can disguise its role in the death saves paradigm with a more clever mechanic. Players will be more satisfied with losing out on their desired auto-crit if the narrative supports that the fallen PC is still in the game.

The Fix

Our solution is a progressive mechanic that uses all the same conditions, but imposes them with increasing level of severity. This adds additional drama to each death save not only due to the threat of dying, but due to the threat of not being able to help your party (and therefore yourself).

  • 0 Failed Death Saves: Prone (Cannot Stand)
  • 1 Failed Death Save: Incapacitated
  • 3 Failed Death Saves: Dead
  • More Fails than Saves: Unconscious

Falling prone at zero HP signals that you do not have any more energy to fight. You have collapsed from the toll the battle has taken on you. While you cannot stand, your speed does not become 0, so you can still crawl around and take actions and make attacks at disadvantage in a last-ditch effort to defend yourself from the onslaught of death. You may also want to have casters drop concentration at zero HP.

On your first failed save, you become incapacitated. You have lost the power to fight. You can no longer impact the battle in a meaningful way, but you can still crawl around, grab McGuffins, and tell your teammates how you really feel about them before your dying breath.

Any time you have more failed death saves than successful saves, you are unconscious. Your unresponsiveness serves as a mechanical signal to your team that you’re not doing so hot, whereas under the current system they have no idea how many death saves you’ve passed or failed without metagaming. This also adds additional drama to each roll, since you can slip in and out of consciousness. Imagine you’ve fallen unconscious, and you revive with one last gasp of air to take your final act. On the flip side of the narrative, bad guys now have a legitimate reason to ignore an unconscious creature, who is surely slipping towards death, compared with the usual 60% survival rate for a creature in death saves.

Once you roll three successes, you’re stuck with whatever conditions you had while you were in death saves (since the system can’t let you end unconscious, as per RAW). Imagine how this would lead to dramatic results, like the last living party member crawling back to town.

If you want some more death saves hacks, check out our alternative Meat Grinder Mode suggestions. Support us on the ThinkDM Patreon, where you can get additional content, early releases, and personalized help on your own design!

14 thoughts on “Death Saves Revived

  1. Here are my crunchy Death Save rules

    0 HP – Automatically fall Prone, gain one level of Exhaustion. Cannot take reactions.

    1st Success: Can move or take one action or bonus action
    2nd Success: Can move and take one action or bonus action
    3rd Success: Gain 1 Hit Point if no Failures, otherwise fall Unconscious and stabilize at 0 hp

    1st Failure: Stunned until beginning of next turn
    2nd Failure: Fall Prone and gain another level of Exhaustion if at least one Success, otherwise Unconscious
    3rd Failure: Dead if no Successes, Prone & Stunned if at least one Success, healing magic does not work, dies in one minute


    1. I’m curious. On a first successful death save using this, would you allow the PC to use the Dash action (increase movement by amount equal to their speed, usually doubling movement) to get up and move? Or is it an exclusive choice between moving and the action? I’m also imagining using misty step to teleport away, since it costs half speed to stand up while prone. Pretty interesting house rules!


  2. An interesting point on what you mentioned about the unconscious creature not being able to see: the 5e unconscious condition actually doesn’t list the creature being blind – just “unaware.” (I would personally run it as if they’re blind.) What it does list is that attacks against the unconscious creature are made at advantage.

    The prone condition lists that attacks made within 5 feet are at advantage – regardless of melee or ranged. And ranged attacks are only at disadvantage if there are hostile creatures (that aren’t incapacitated) within 5 feet of the ranged attacker or if the attacker is beyond 5 feet of the target. So if that ranged attacker moves within 5 feet of the lone unconscious creature, they’ll actually be attacking with advantage! Otherwise, it’ll be a regular roll beyond 5 feet.

    I just learned this today, by the way. Lol


  3. This is an interesting idea, as is Mr. Brown’s. My campaign imposes “hit 0 HP, gain a level of Exhaustion”, and uses hidden Death Saves; otherwise the rules are RAW. Oh, but one external rule – I use both a “Luck Point” (short term, 1 bonus roll), and a “Fate Point” (one per level, auto-succeed one roll) mechanic. A Luck Point will cancel a failed Death Save – it does not make the roll a success, though. A Fate Point will allow you to act at Death’s Door (you are still at 0 HP, but functional — but with that level of Exhaustion).

    The big thing is that a mobile/functioning target is just that: a TARGET. These suggestions mean the PCs remain valid targets. They will be attacked and killed. Anything with multiattack will kill your character in a single round – maybe two, by quickly inflicting 2 or 3 “failed Death Saves”, because you were still a threat. *especially* if that prone PC is casting spells or attacking!


  4. The issue I see is this makes it really hard to ever down a paladin or healer as they can just use their first turn to heal themselves. Or really anyone who has a healing potion. This makes going down less scary especially if it is the healer as the players would be able to assume they could heal themselves most of the time.

    Making it so they can’t use spells on themselves would be a weird addition to the rules.

    I like the idea of them being able to crawl or to use an object in the world. It just is a hard balance. It is fairly hard to die in 5e and while the knock out mechanic is boring it does work to make things more intense.

    Good article though.


    1. Remember that you need to pass your first death save at the beginning of your first turn. So you won’t be guaranteed to heal yourself. To me, that imparts an interesting calculus for the attacker, who can decide to coup de gras or deal with more imminent threats.

      Action restrictions are totally valid, though. My goal was just to get you thinking about how to improve if for your own game.

      Thank you for your comment!


    2. My thought was to (a) only remove 2 levels of exhaustion when restored to 1+ HP, and clarify that taking an action while at 0 HP requires a Death Save *EVEN IF THAT ACTION HEALS YOU*. So while the paladin can get himself back in working order, he might still acquire that last Death Point doing so, and fall over dead.


      1. Ah, so a risk-reward mechanic. Interesting! Another way to help limit action abuse could be to require a successful DC 10 or 15 Consitution saving throw in order to take an action.


  5. This is quite brilliant! It definitely needs a bit of polishing as pointed out by other comments as to not make characters even more resilient than they already are, but this could tremendously increase the drama involved with dying. I’m going to have to try this out!


  6. I love these rules! I think the only change I would make is requiring another death saving throw immediately before taking an action on your turn, if you choose to. Doing anything except crawling away risks killing you outright if you roll a 1 after you already have 1 failure.
    As for coup de grace, I think I would only allow an automatic hit and kill if there were no other combatants around. I still think there should be a chance of failing if there are other enemies around stressing you out and getting in your way.


    1. Also, I’ve recently implemented lingering injuries whenever you drop to 0 hit points, which has been great. Getting that close to death should be a heck of an ordeal.


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