Lingering Injuries, as written, seems like it will just force the group to always keep a HD in reserve, however. Hmm, that may be so. I didn't think about that. Practically speaking, what this could mean is that healers have the option to cast spells other than healing until the hit dice fall to low levels at which point they end up casting more healing spells than other spells. That kinda makes sense actually... the lower the PCs are in reserves, the more they have to lean on the cleric. Unfortunately, this puts the burden on the cleric to have less versatility as the adventure wears on. On the other hand, that's true of any spellcaster as they burn through spells anyway. Tough call. I often look to hit dice as a resource that the PCs can lose if they fail a skill challenge type scenario e.g. screw up navigating the raging rapids and everyone loses a hit die. So in a game like mine, you could probably try to keep that 1 hit die in reserve, but there's always the risk you lose it when you fail a skill challenge. That might be an option for you. I'd actually dispense with injuries on crits or failed death saving throws anyway--it's much harder to control if you are crit against than it is to control whether you drop to 0, and failing a death saving throw feels like adding insult to injury. The best way to avoid criticals is to hinder the enemy in some way that gives them disadvantage on attacks. That might be a fun tactic in some cases. I agree on the "insult to injury." I was just listing what was in the DMG for conditions at which lingering injuries set in. I think I'd prefer to roll Injuries *only* after a character drops to 0, but regardless of how many HD are unspent. If HD represent "the will to go on" it's not clear how they would prevent injury anyway. Perhaps a similar tension could be achieved by allowing a player to spend a HD to reroll the injury? That should keep the table in play, while keeping the spirit of "we must go back to town from time to time or else we risk some pretty grave injuries" I think that could work. Good idea. I'm also interested in the possibility mentioned in those rules to allow individual PCs to optionally choose the mechanical effect of those injuries. So in my games, the rule for Inspiration is that in order to earn Inspiration, the player must choose to take disadvantage on a check or otherwise make a decision that incurs them a real setback or cost, justified by a trait, ideal, bond, or flaw. I do this so that I don't have to monitor their interactions and award it. In practice, this doesn't come up that much. Most players just forget about Inspiration as much as I do. I'd expect the same to occur with regard to the injuries-as-flaw option.