Hit points represent stamina, luck, defensive movement, armor impact, stress, and minor wounds. Losing hit points does not always mean a serious physical injury.
A lasting injury is most appropriate when a character:
Reaches 0 hit points
Suffers a critical hit from a dangerous source
Is struck by a vehicle
Falls from significant height
Takes explosive damage
Fails a death saving throw
Endures another clearly severe event
Franz should not impose a lasting injury after every successful attack.
Use standard D&D 5e death saving throws.
A character at 0 hit points may be unconscious, bleeding, in shock, or critically wounded. Stabilization prevents immediate death but does not restore normal function.
Survival may still require:
First aid
Medical transport
Surgery
Medication
Recovery time
Rehabilitation
Payment or favors
A character who regains hit points may awaken but still suffer a specific injury.
A character may stabilize someone through:
Wisdom (Medicine)
A medical kit
Street Medic training
Emergency medical equipment
Professional assistance
Routine first aid may not require a roll when the caregiver has proper training, supplies, and time.
A check is appropriate when:
Treatment occurs under fire
Supplies are limited
The patient is actively dying
Several injuries must be managed
The patient must be moved quickly
The environment is unsafe
Stabilization stops immediate deterioration. It does not repair major wounds.
Medical kits may contain bandages, gloves, disinfectant, trauma dressings, splints, airway supplies, and basic medication.
Kits should have limited uses when scarcity matters.
A depleted or improvised kit should not provide the same benefit as a fully stocked trauma bag.
Street Medics provide discreet treatment outside the formal healthcare system.
They may operate from:
Hidden clinics
Apartments
Garages
Vans
Safehouses
Nightclub back rooms
Temporary field stations
Their advantages may include fewer identity checks, reduced police attention, flexible payment, and stronger underworld connections.
Their limitations may include:
Limited supplies
Poor sanitation
Few assistants
No advanced imaging
Restricted medication
Weak surgical facilities
Faction pressure
Street medicine is not magical healing.
Street Medic features may represent:
Stopping blood loss
Stabilizing critical injuries
Applying pressure dressings
Managing shock
Administering medication
Moving injured allies safely
Temporarily reducing pain
Supporting recovery
A Street Medic may keep someone functioning through treatment, adrenaline, or pain control, but serious wounds still require later care.
Hospitals provide access to:
Emergency surgery
Diagnostic imaging
Blood transfusions
Intensive care
Specialists
Prescription medication
Rehabilitation
Long-term treatment
Hospitals also create records.
A hospital visit may produce:
Identification records
Billing information
Security footage
Visitor logs
Injury reports
Prescription records
Blood samples
Removed bullets or fragments
Staff witnesses
Characters with Heat, warrants, false identities, or suspicious injuries may attract police attention.
Hospitals may report:
Gunshot wounds
Stab wounds
Explosive injuries
Suspected abuse
Unidentified patients
Injuries connected to major crimes
Wanted suspects
Reporting depends on hospital policy, local law, staff judgment, political pressure, and corruption.
A false identity or bribed employee may delay attention, but rarely erases every record.
Private clinics serve wealthy clients who want speed, comfort, discretion, and strong security.
They may offer:
Private entrances
Specialist treatment
Secure rooms
Reduced waiting time
Confidential staff
Private transport
Reputation management
Private care is expensive and still usually creates records.
Underground clinics treat people who cannot safely use hospitals, including criminals, fugitives, uninsured residents, trafficking victims, undocumented workers, and faction members.
The Clinic is an established POI. Its staff, security, services, prices, and faction ties belong in its POI record.
Underground treatment may cost cash, supplies, information, protection, or future favors.
Severe injuries may require:
Removing bullets or fragments
Stopping internal bleeding
Repairing damaged organs
Setting serious fractures
Treating burns
Repairing blood vessels
Amputation
Reconstructive surgery
Surgery requires trained personnel, proper equipment, medication, and time.
Improvised surgery may increase the risk of infection, disability, blood loss, or death.
Recovery depends on injury severity, Constitution, treatment quality, rest, and rehabilitation.
General guidance:
Minor injury: Hours to several days
Moderate injury: Several days to several weeks
Severe injury: Weeks or months
Permanent injury: Ongoing treatment or adaptation
Franz should avoid excessive downtime unless it creates meaningful choices.
A character may return to activity before full recovery while still suffering pain, fatigue, reduced movement, or disadvantage on related checks.
A short rest may represent:
Catching breath
Cleaning wounds
Bandaging
Eating and hydrating
Taking medication
Regaining focus
A long rest represents meaningful sleep, food, safety, and treatment.
Rest may restore hit points under D&D 5e rules, but it does not instantly repair:
Broken bones
Organ damage
Severe burns
Major blood loss
Surgical wounds
Lost limbs
Hit points may recover while a specific injury remains relevant.
A serious injury may cause a temporary effect such as:
Reduced speed
Disadvantage on Strength checks
Disadvantage on Dexterity checks
Limited use of one arm
Reduced carrying capacity
Difficulty concentrating
Pain during strenuous activity
The effect should match the injury.
Franz should explain how long it may last and what treatment is required.
Permanent injuries should be rare and usually follow extreme harm, repeated failed treatment, or a player-approved consequence.
Possible permanent effects include:
Lasting scars
Chronic pain
Hearing loss
Reduced vision
Nerve damage
Reduced mobility
Loss of a limb
Characters may adapt through therapy, prosthetics, specialized equipment, and retraining.
Permanent injury should create story opportunities rather than simply remove the character from play.
Infection may follow:
Untreated wounds
Dirty surgery
Contaminated tools
Severe burns
Poor sanitation
Delayed treatment
Treatment may require antibiotics, drainage, surgery, hospitalization, or extended rest.
Complications should arise from believable circumstances rather than random punishment.
Medical expenses may include:
Ambulance transport
Emergency treatment
Surgery
Medication
Hospital stays
Rehabilitation
Private security
False records
Underground treatment
Characters unable to pay may face:
Medical debt
Faction obligations
Pressure from collectors
Seized property
Criminal employment
Demands for future favors
Community clinics and Street Medics may accept supplies, protection, labor, or information instead of money.
Medical treatment may create evidence through:
Blood samples
Removed bullets
Injury photographs
Patient records
Payment records
Security footage
Visitor logs
Prescription records
Staff testimony
Destroying one record does not remove every trace.
A recovered bullet, distinctive wound, or treatment record may connect a patient to a crime.
Moving a badly injured person may worsen their condition.
Safe movement may require:
Stabilization first
A stretcher
Another person’s assistance
A vehicle
A Medicine check
Protection from further harm
Dragging someone quickly may be necessary during combat, but it may carry additional risk.
Medical transport may involve:
Ambulance
Private vehicle
Wheelman
Police transport
Casino security
Corporate medical teams
Improvised transport
Response time depends on traffic, district, road access, police activity, and current Heat.
Sin City has no magical resurrection.
A dead character remains dead unless the event falls within a brief, medically plausible resuscitation window and proper treatment is immediately available.
Resuscitation may involve:
CPR
Defibrillation
Airway support
Emergency medication
Trauma surgery
Franz should not reverse an established death through implausible recovery.
A conscious patient may usually refuse treatment.
Medical workers may face conflicts involving:
Patient confidentiality
Police requests
Faction threats
Unconscious patients
Trafficking victims
Suspected abuse
Immediate public danger
Social checks should not automatically force a medical professional to abandon core ethics without strong leverage, corruption, or fear.
Injuries should create consequences, vulnerability, and difficult choices without making the campaign unplayable.
Franz should track:
Serious wounds
Treatment received
Available supplies
Medical records
Recovery time
Costs and debts
Ongoing limitations
Healing comes from medicine, equipment, rest, and skilled care—never magic.