The Heal Skill is one that often gets overlooked by most people since magic tends to replace its usefulness quite easily. In those few times that nobody has any healing spells or potions and a comrade’s lying on the ground dying, the rest of the PCs take turn making untrained Heal checks hoping for a high roll.
I think some changes are in order.
The Problems
The main problems with the Heal skill, in my opinion, are:
- You can make untrained checks – if someone just stabbed me with a sword, I don’t want some butterfingers poking around without knowing what they’re doing. I want a doctor, damn it.
- There’s no consequence for failure – we’re dealing with people that are hurt. If you don’t know what you’re doing, then you shouldn’t be touching them – because you can easily hurt them further.
- There’s a flat DC for success – this is regardless of the degree of injury or your familiarity with the target’s anatomy or race.
- The skill simply assumes you can assess if someone’s dead or dying – this is again regardless of your familiarity with their anatomy or race and ignores that as someone gets closer to death that it’s more difficult to discern the difference between the two.
Unless otherwise noted, the proposed changes are in regards to the First Aid function of Heal. Most of the other aspects are fine the way they are.
In classic Scrag style, it’s now time to break each point down in turn, suggest changes and roll it all up in the end.
1. Heal Shouldn’t Be Untrained
I’d wager that > 90% of all Heal checks made are to stabilize a fallen comrade. As such, the vast majority of DCs that are needed are 15′s. Assuming that you have someone in the party with a decent Wisdom, even if they don’t have any ranks in healing, they’ll still succeed a bit under 50% of the time. If that person fails for some reason, there’s still no reason everyone in line behind them shouldn’t give it a go since a DC 15 is far from unattainable. This leads us into the second point quite well.
It seems odd that you can’t Tumble or Handle Animal untrained, yet someone with zero experience is capable of stopping someone from dying.
2. Oww! You’re hurting me!
This is another very easy scenario to envision. If you botch a heal check, it only stands to reason that it’s because you did something wrong. The severity of your mistake should have a potential to do more damage than good.
The tricky part is making sure that the effect of failure isn’t too severe. The margin of error here is generally measured between -1 to -9 hp. We have to keep this in mind as we spec out an appropriate consequence.
When trying to stabilize a fallen comrade that is currently dying, if you fail the target DC by 5 or more, you inadvertently hurt the target and deal 1 point of damage. You can make successive heal checks after that until the target is either healed or dies.
3. Some Wounds Are Harder To Heal Than Others
Let’s face it, some things are harder to do than others, even if you’re using the same skill set. Healing is no different. If someone gets knocked out from a decent bonk on the head (drops them to -1 hp), they’ll be easier to bring back to consciousness than someone that’s been stabbed through the belly with a sword (dropping them to -7 hp).
The descriptions there are all flavor text and largely irrelevant. The numbers are really what we’re interested in.
In addition to this, however, is the fact that a human without much experience in other races shouldn’t have the same ease in healing a creature type that they’re wholly unfamiliar with – such as a Beholder or Rust Monster. The fact that a PC likely won’t be healing these sorts of creatures is irrelevant. We need to make sure that our rules apply to all situations evenly.
My proposed DC is as follows:
Base 15 DC + one for every point below zero. Add up to 10 to the DC for creature types and races that the healer is unfamiliar with.
The only variable in the mix for the DM to decide is the familiarity that the PC has. I’m giving a wide range to work with so the DM can be as tough or easy on the PC as appropriate.
4. Is It Dead?
We’ve heard this question asked quite a bit in a variety of bad horror flicks. The main function is to allow you to determine if something is in the Dying state or has already died. The current rules just assume that you know what the target’s state is – which seems naive to me. I simply don’t believe a healer can do an adequate job of helping someone if they’re unable to even determine if the target is alive or not.
If the creature is stable, but still negative, then they are able to talk and you know they’re alive. Playing dead would be an easy scenario to take into consideration – their Bluff vs. your Sense Motive check. The DM can add appropriate modifiers for how hurt the target appears (e.g., how believable the Bluff is).
If the creature is dying, but not dead (e.g., hasn’t stabilized yet), then you should be able to make a Heal check DC 5 + one for every point below zero plus the same racial modifier for unfamiliar creature types. Failure would indicate that you think it’s probably dead, but you’re not quite sure.
If the creature is dead, the DC is 5 plus the racial modifier for unfamiliarity.
You can discern if a creature is dead or dying as a free part of your Heal check before you begin. There is no negative consequence for failure, but you must determine that a creature is in the Dying state prior to administering First Aid. If you fail the first check, you can make a second check that round as a standard action. Each round after the first, checking to see if the creature is alive or not is a standard action (e.g., only one can be made per round).
Other Bits
Aid Another is a tactic that parties either never do or do for virtually all checks that allow it. Healing is a skill that should gain the benefit of assistance. It’s also usually a very delicate task where “too many chefs can ruin the pot”. Since Aid Another doesn’t clearly outline how many people can assist in a given task, it’s not unreasonable to put a limit of two people aiding the main healer. Most of the time, the assistance will likely be in the form of someone simply holding items and passing needed tools to the healer. As such, the healer can have up to one person that’s untrained in the Heal skill make an untrained check to assist.
The New Mechanics
The changes we’ve made are really three-fold.
- Heal is no longer an untrained skill
- First Aid has been revised to finally make some sense
- We added a new ability “Determine State” (to tell if someone’s dead or dying)
Let’s just write out what the new versions of First Aid and Determine State are.
Determine State
As you begin a Heal check, you can take a free action to determine the state of the target. This will tell you if they’re dead or dying. If you fail the first check, you can make a second check that round as a standard action. Each round after the first, checking to see if the creature is alive or not is a standard action (e.g., only one check can be made per round).
If the creature is dying, but not dead (e.g., hasn’t been stabilized yet), then you can make a Heal check DC 5 + one for every point below zero plus the same racial modifier for unfamiliar creature types to determine if they are alive or not. Failure would indicate that you think it’s probably dead, but you’re not sure.
If the creature is dead, the DC is 5 plus the racial modifier for unfamiliarity.
There is no negative consequence for failure, but you must determine that a creature is in the dying state prior to administering First Aid.
That’s all pretty straight forward as noted above.
First Aid
Once you’ve determined that someone is in the dying state, you can attempt to administer First Aid to stabilize them.
The heal DC is 15 + one for every point below zero. Add up to 10 to the DC for creature types and races that the healer is unfamiliar with.
Success means that the target is immediately stabilized and stops losing hit points.
If you fail the target DC by 5 or more, you immediately cause one point of damage (this happens on your turn) to the target. You can make successive heal checks after that until the target is either healed or dies. Failure of the target DC by 1 to 4 results in no progress and no harm to the target. The target still loses one point each round on their turn they are in the dying state until dead or stabilized.
Note that since the DC is based on the target’s current hit point total, the DC has the potential to change each round.
And there you have it.
Wrapping It Up
This makes the Heal skill a bit more complicated in some regards (the fact that you need to determine if the person is dead or dying and the First Aid DC is variable) but also makes it a valuable skill for those that have invested in it. These changes also align the Heal skill more with “reality”.
Any skill that can be used untrained loses some of its value to characters that tend to invest in it – especially if this is an “external” skill (one that you use to effect the environment around you, such as Disable Device or Diplomacy). “Internal” skills (such as Jump or Hide) don’t have this same issue. In a sense, it’s the “hero factor” that you’re robbing the PC of. The ability to make trained-only skill checks is a reward for investing in those skills.