Downed Mechanics
Purpose: This mechanic is intended to allow the party a chance to save dying teammates, without making it inconsequential when someone gets downed.
Reaching 0 HP is the point where characters start to actively pass from their injuries, and are unable to stay conscious. In my campaigns I prefer to have death be a bit more of a threat than standard D&D, where saving throw rules either trivialize death, or allow someone who is down to die before anyone has a chance to heal them. Instead of rolling death saving throws while downed, it is represented by a pool of downed health. This health is equal to half of your maximum health. Whenever you start your turn downed, the DM must roll a die of the type that damaged you last, representing your character bleeding out (so if you were downed by firebolt, you take 1d10 in bleeding damage at the start of your next turn). When you are downed, further attacks will injure no matter the damage taken.
Injuries
Purpose: This mechanic is intended to introduce an element of realism and danger to combat, while offering new opportunities for roleplaying.
When taking more damage than a quarter of your maximum health at once, gain an injury. The injury is determined by the DM based on location, damage type, damage taken, and any other factors that could influence an injury. Lacerations will almost always lead to severe bleeding that will require pressure to stop and may lead to nerve damage, bludgeoning will often break or fracture bones or cause internal bleeding, fire will cause severe burns, etc.
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