DEATH THRESHOLD: Your death threshold is a negative number equal to your maximum hit points or your Constitution score (whichever is greater). For example, if you have a maximum of 23 hit points, then your death threshold is -23.
ALIVE: You are alive as long as your current hit points are above your death threshold.
DEAD: You are dead if your current hit points are below your death threshold. Dead characters automatically lose 1 hp per round.
DISABLED
Once you reach 0 hit points you are considered disabled. A disabled character move at half speed and may only take a partial action each round. Disabled characters who perform a standard action (or any other strenuous action, such as casting a quickened spell) take 1 hp of damage after the action.
While you’re disabled, you must make a Fortitude save (DC 10 + the number of hit points below zero) each time you take damage (including the damage which resulted in you becoming disabled). If you fail this save you fall unconscious.
Unless you have stabilized (see below), you take 1 hp of damage per round while disabled.
STABILIZED
TENDED CHARACTERS: A disabled character can be helped with a first aid check (Heal, DC 15). On a success, the character stabilizes and begins healing naturally.
UNTENDED CHARACTERS: A disabled character without assistance who takes no action in a round has a 10% chance of stabilizing. Even after stabilizing they may still take additional damage, however: Each day they must make a 10% roll to start healing naturally. If they fail this check, they instead suffer 1 hp of damage and must check again the next day
WAKING UP: Once an unconscious disabled character has been stabilized, they have a 10% chance of waking up each hour. An untended character (who has not benefited from a first aid check) who fails to wake up also takes 1 hp of damage with each failed check.
HEALING
NATURAL HEALING: After a full night’s rest (8 hours of sleep or more), you recover 1 hit point per character level. Any significant interruption during your rest prevents you from healing that night. If you undergo complete bed rest for an entire day and night, you recover twice your character level in hit points.
MAGICAL HEALING: Magical healing spells are maximized (they always restore the maximum possible number of hit points). Any magical healing automatically stabilizes a character. A character unconscious as a result of their injuries also wakes up as a result of magical healing.
RESURRECTION
There are no spells which return the dead to life (raise dead, etc.). However, even dead characters can benefit from magical healing and are returned to life if their hit point total is raised above the death threshold. After 24 hours of death, however, a character is lost forever and cannot be returned to life.
GENTLE REPOSE: A gentle repose spell temporarily stops the loss of hit points a dead character suffers. It also extends the period of time in which a character can be revived.
CONSTITUTION SCORE DAMAGE
Characters reduced to 0 Constitution are dead, but still have whatever hit points were left to them. They still lose 1 hit point per round until their Constitution is raised to at least 1. If their hit points drop below their death threshold, it will be necessary to raise both their Constitution and their hit points in order to return them to life.
Note: Clerics may spontaneously cast lesser restoration, restoration, and greater restoration spells as if they were cure spells.
DEATH EFFECTS
Any special ability or spell that results in death instead causes 4d6 points of Constitution damage. On a successful save, the special ability or spell causes 2 points of Constitution damage (instead of whatever effect a save would normally have).
MASSIVE DAMAGE THRESHOLD
There is no massive damage threshold.
DESIGN NOTES
These are my personal house rules for death and dying in 3rd Edition. They weren’t conceived all at once, nor were they designed to overcome any kind of serious mechanical flaw in the system. Rather, they’re a slow accretion of various tweaks which I use to change the flavor of death in the game.
THE UNDISCOVERED COUNTRY
The first set of changes I put into place was the removal of raise dead, resurrection, and similar spells. The motivation here was relatively simple: I don’t like the revolving door of death. Death is a powerful and dramatic event… unless, of course, it happens at the gaming table. At the gaming table it’s usually a joke. Or, at worst, a minor inconvenience.
This problem of flavor goes beyond de-valuing the meaning of death. With even a modicum of logical thought, it completely changes the nature of the game world. At the most obvious level, you will never have a story which begins “when the old king died in the Battle of Batok’s Pass”. You also have to realize that assassination becomes almost pointless: In such a world, the country doesn’t go into mourning when JFK is shot in Dallas… it criticizes him for being a narcissistic slacker when he refuses to respond to the raise dead spell.
It gets more severe (and more bizarre) from there.
These kinds of thought experiments and what-if games can certainly have interesting results. But I’ll confess that I’m generally looking for something that looks a bit more like Middle Earth and a lot less like transhumanist fantasy (which sounds like a fascinating, albeit largely untapped, sub-genre).
So I got rid of raise dead.
But this creates a new problem: It’s a lethal game. And I like combat to be risky. Combining risky combat with an absolute barrier between life and death will result in a lot of new characters being rolled up. The revolving door may be gone, but death still becomes de-valued because players stop investing themselves in characters they know have the life expectancy of tissue paper in a blast furnace.
More precisely, I didn’t want to increase the actual lethality of the game (measured in characters permanently removed from gameplay). Nor did I want to decrease the challenges of the game. I needed to shift the flavor without shifting the gameplay.
The solution was to re-imagine what the -10 hit point barrier meant: It was still a death of the body, but not a departure of the soul. Thus, clerics could use their divine healing to bring back even those whose bodies had been punished beyond the point of natural healing.
The result is a mechanic that looks a bit more like an emergency room resuscitation than Jesus rising from the dead.
This is a subtle change, but one that removes the flavor problems that come from a hero’s spirit constantly yo-yoing between this world and the next.
LOW-LEVEL LETHALITY
For many years, this was the only change I made to the death and dying rules. Playtesting did reveal a few problem areas that needed to be dealt with, but for the most part these rules worked and worked well.
One early discovery was that Constitution damage had suddenly become much more horrible. In the standard game, the difference between dying from Constitution damage and dying from hit point damage was non-existent: In either case, you needed a raise dead spell to bring you back. But, under the new rules, hit point damage could simply be healed through spontaneous casting whereas Constitution damage would frequently require a prepared restoration spell… at which point the character’s moldering corpse would have accrued a huge tally of negative hit points.
This led to the simple expedient of allowing clerics to also spontaneously cast restoration spells.
The other effect of this rule change was to smooth out the differences between low- and mid-level play. Using the standard rules, low-level characters have a practical barrier between life-and-death. While they might theoretically be raised from the dead, in practice the party lacks the resources to afford a raise dead spell. Plus, given the low-levels involved, there’s a minimal investment in the existing character and a minimal time commitment required to roll up a new character.
And then, for a few levels, coming back from the dead becomes a possibility, but an expensive one: The cost of getting the spell cast will seriously deplete the party’s resources.
And then death becomes a speed bump.
This is one of the things that leads to the perception that low-level play is so much more difficult and lethal than high-level play: Not only do you have a smaller pool of hit points and a smaller margin for error, but the barrier between life-and-death still exists — so death is death and you’re not coming back.
Under these house rules, on the other hand, this continuum is made a little less extreme: Low-level characters can hit -10 and still be brought back.
HIGH-LEVEL LETHALITY
Speaking of that -10 barrier, we come to a widely-recognized shortcoming in mid- and high-level play: The tougher you become, the more likely you are to die than you are to fall unconscious.
Why? Because, as the average damage inflicted by any given blow increases, the chance that any given blow will catapult you directly from positive hit points to negative hit points and death increases. For example, if you suffer a blow for 5 hp there is no chance that you’ll be immediately killed by it. If you’re suffering blows doing an average of 25 hp, on the other hand, the odds drastically increase for such an opportunity.
The solution for this is to increase the number of negative hit points a higher level character can suffer before actually dying. And the simplest solution for this is to give everyone the same number of hit points below 0 as they do above 0.
DECOUPLING DYING
Finally, I had a desire to decouple unconsciousness and dying. There are a couple of reasons for this:
First, one of the shortcomings of the game has always been its inability to handle a person’s “dying words” or “final effort”. It’s a literary classic: The dying man exerts just enough energy to whisper, “Your mother yet lives!” or “Rosebud!” or “From hell’s teeth I spit at you!” Or perhaps the dying heroine manages to hold onto the detonation device until her companions have escaped. But, in the game, a dying character is always unconscious — and thus unable of uttering dying words, making a final heroic gesture, or anything else. They can’t even bandage their own wounds.
Second, I’ve always liked the mechanics for being disabled: There’s something dramatic about a wound so severe that taking any strenuous action is literally making your wounds worse. It forces a desperate, bleeding retreat; or it offers the hero a chance to grit their teeth and achieve something remarkable; or it leaves the villain staggering as the hero surges forward for their triumph.
But, unfortunately, the disabled condition only happens when a character lands precisely at 0 hit points. And then it only lasts for, at most, a single round before they keel over into unconsciousness.
Both of these problems can be solved by decoupling dying and unconsciousness, as shown in the house rules.
And, as ancillary benefit, this mechanic also allows the dying condition to serve as a “warning track” of sorts. Instead of just plugging away at full power until, suddenly, the character is completely out of it, now a PC is more likely to enter the dying state and be able to do something about it: Bind their wounds. Call out for the cleric. Gulp down a healing potion.
THE PROBLEM OF UNCONSCIOUSNESS
One problem I haven’t solved yet is the problem of unconsciousness. More specifically, the problem of waking someone up who has been unconscious.
In real life, if someone gets knocked unconscious you can frequently (but not always) wake them up again by slapping them, throwing water in their face, or waving smelling salts under their nose. In the game, however, this doesn’t work. If you’ve hurt someone enough to knock them unconscious, the only thing you can do is either (a) magically heal them or (b) wait a very long time for them to naturally heal some damage.
This is a shortcoming, as my players frequently want to model that narrative conceit of slapping a prisoner awake so that they can question them. (Ironically, this can only drive them deeper into unconsciousness using the rules.) Unfortunately, I haven’t figured out any particularly good way (and a simple way) to overcome this shortcoming.
Anyone have thoughts on the matter?
ARCHIVED HALOSCAN COMMENTS
Muninn
Just asking two points of clarification:
First, Does “A disabled character moves at half speed and may only take a partial action each round” mean that A character’s move-speed is halved in addition to the fact that they can only take one move action per turn, or does it mean that their movement is effectively halved, due to them only being able to move once during their turn instead of twice?
Secondly, characters have to make a save each time they take damage or fall unconscious. Does this include the 1 damage per round from being disabled, or only from things such as attacks, environment, etc?
Friday, December 03, 2010, 12:08:03 AM
Matt
From a realism standpoint knocking someone unconscious by surprising them and dealing them a quick blow to the head is a result of head trauma. Being unconscious after fighting in melee/magical combat is likely the result of loss of blood or shock. The game models this difference through the non-lethal damage mechanic. The only issue I have with it currently is it’s not very easy to knock someone unconscious in one blow with non-lethal damage even as a rogue using a sneak attack. The way I let my players replicate knocking someone out (to interrogate later, or maybe just because they don’t want to kill) is when dealing non-lethal damage they treat unaware characters as helpless and may use the coup de grace rules (AOOs still apply if they do).
Friday, May 21, 2010, 1:26:28 AM
Predrag
I liked your house rules for death so much, that i began to use it in all of my games. Needles to say, my players have, at first been mortified, but then delighted by them. There is a nifty rule we came up with that settled unconsciousness for us: If a character falls unconscious, another PC or NPC can bring them back with a slap or a punch to the chest (heal DC15), wave smell-salts in front of their nose (automatic) or by applying a small amount of electrical damage (like a jolt from a 0-lvl spell). The character will awake and be conscious long enough to take a standard action (drink a potion etc) after which he/she must make a fortitude save or fall unconscious again.
Wednesday, May 19, 2010, 4:51:55 AM
R3miel7
For unconsciousness, why not have an unconsious character heal non-lethal damage at a vastly accelerated rate if someone is trying to wake them up. Like, a splash of water in the face heals 10 non-lethal damage. I’m not gonna balance the system, but that way people can be woken up when something important is happening but will stay knocked out if you want them knocked out
Friday, March 05, 2010, 10:01:05 AM
87392v
Perhaps, to awaken from unconsciousness, the attempt to awaken needs to be like a skill check or attack roll against [5 + points unconscious].
So, say, for a slap to wake someone at -8 HP, one would make a Strength check DC 13.
Or perhaps, as with shocks like cold water, an arbitrary modifier would assist the waker’s d20 roll against the DC 13. Maybe the 1d6 that would normally add cold damage to attacks is instead added to the roll.
Unless a 1 is rolled, none of the waking attempts would cause damage, of course.
Sunday, March 01, 2009, 9:09:26 PM
Danhelm
A rogues that launches a sneak attack with a sap can convert all their damage to subdual damage. So it allows rogues to knock people unconscious without actually having to seriously injure somebody. I think you can do this with the “improved unarmed strike” feat as well.
Of course, you still can’t slap that unconscious character awake. But maybe that’s only reasonable if you’ve just beaned somebody over the head.
Tuesday, November 25, 2008, 6:17:19 PM
Pekkias
In d20 modern you can revive an unconscious character with Treat injury skill (=Heal)
Revive Dazed, Stunned, or Unconscious Character (DC 15): With a first aid kit, the character can remove the dazed, stunned, or unconscious condition from a character. This check is an attack action.
A successful check removes the dazed, stunned, or unconscious condition from an affected character. The character cant revive an unconscious character who is at 1 hit points or lower without first stabilizing the character.
Sunday, November 02, 2008, 1:45:12 AM
Strange_Person
What about making a distinction between “unconscious” and “asleep?” When someone stabilizes, their condition changes from unconsciousness to natural sleep, and they can be awakened by anything that would wake up a sleeping person normally, including loud noises and physical contact. The 10% per hour chance of waking up represents the chance of some random environmental factor disturbing them, and the progressive damage represents either ‘strenuous’ attempts at sleepwalking, or otherwise-harmless insects moving in on the blood buffet.
Another issue: with the system so far, a severely-wounded person who doesn’t care about taking damage is no less able to act than someone under a Slow spell. Perhaps, to reflect the pain, blood loss, and so on, disabled characters could take a penalty to all attack rolls and skill checks equal to the square root of how many HP they are below zero, rounded down. For example, someone at -15 HP would be rolling everything but saving throws at -3, and if they’re trying to fight on, next round the penalty increases to -4.
Saturday, May 10, 2008, 3:36:02 PM
Justin Alexander
@Lior. Well, there is subdual/nonlethal damage for that. But even when you’ve been rendered unconscious due to nonlethal damage (and, thus, have positive hit points) there’s still no easy way to wake someone up. Healing a point of nonlethal damage naturally takes less time than lethal damage, but it’s still at least an hour.
Friday, May 09, 2008, 4:57:09 AM
Lior
Regarding the last question, I think your problem is that in real life you can become unconcious without suffering major damage. In addition to losing conciousness due to a major injury (usually due to blood loss or shock), a hit to the head can also cause you to lose conciousness. This can happen in unarmed combat, or simply by falling down the stairs.
In real life, it will be quite a challenge to awaken someone who suffered massive blood loss without first administering first aid and bringing them back to “positive hit points”. Contrast this with the prisoner your players want to slap awake, who was probably knocked out cold rather than suffering so much damage to be at death’s door (perhaps, after suffering such damage, he has healed enough to be at positive hit points again, but isn’t yet awake).
To conclude, what you need is a mechanism for characters to be simultaneously unconcious and at positive hit points.
Wednesday, April 16, 2008, 1:54:38 AM
Reltzik
Yeah, the unconscious thing always bothered me too. And it’s not just outright damage; realisticly, pain should be enough to make someone lapse unconscious. One possibility is to take Massive Damage and replace the death consequence with unconsciousness. Another one is to call for fort saves with a DC based on the damage dealt, regardless of whether that damage is lethal or subdual.
Waking them up’s easy. Make it a DC 10 heal check, perhaps with a +2 circumstance modifier to DC for every negative hit point. (Or if you’re using the death at -HP rather than -10 rule, +1 for every 5% of their hit points they’re in the negative on, so someone with 40 HP max at -12 requires a DC 16 check.) Anyone can try it, even untrained – slap their cheeks or splash water in their face. However, the SMART person knows that waking up a dying person isn’t smart, because they’re likley to take standard actions and make things worse. This leads to the scene in the hospital room where the doctor refuses to wake the patients because it could harm them.
Sunday, March 09, 2008, 1:33:00 AM
Justin Alexander
I like the thoughts here.
So we’re thinking something like a Massive Damage save — except with a lower damage threshold. If you exceed that threshold, make a Fortitude save to stay conscious.
And then if you’re unconscious, something like the “awaken” action can prompt a new saving throw to wake you up.
Friday, February 15, 2008, 3:46:49 PM
RodTheWorm
I like the large amount of damage causing unconsciousness thing here as well as the main article. It always seemed crazy to me that a rogue can sneak attack someone with a club from behind but can’t knock them out without leaving them dying. You see people do stuff like that in films all the time.
Perhaps the ‘slapping awake’ thing could be modelled by an ‘awaken’ action? Whether by chucking water over them, using the smelling salts or slapping them awake, this would give the unconscious person the opportunity to make another Fortitude save to wake up again.
Monday, January 14, 2008, 8:33:16 PM
Todd Kes
Regarding the possibility of knocking someone unconscious without killing them, one option would be that using large amounts of damage would shock the other person into passing out. I.e. damage taken in one attack greater than their Con value.
The difficulty check would be modified by how much damage exceeded their Con value. If they fail the check they fall unconscious, but are not in negative hit points.
A second option would be rolling for consciousness when they get below their Con value in hit points. Essentially the target has been battered enough that they are about to pass out, and they do. This is only done when they take damage, so they do not have to roll every turn.
The other option is classifying certain types of damage as non-lethal, and reducing their hit points via this non-lethal damage (which cannot reduce someone below zero). I.e. punching someone out.
(mainly tossing out ideas to prime the pump, so to speak)
Wednesday, January 09, 2008, 1:24:39 AM
It occurs to me that I’ve neatly and naturally solved the game-world implications of the revolving door of death through application of Calibrating Your Expectations. Which is to say: there are very few NPCs above level 5 in my game, and virtually none above level 10.
A character needs to be 7th level to cast Reincarnate, 9th to cast Raise Dead, 13th to cast Resurrection, and 17th to cast True Resurrection.
I’ve broadened the Reincarnate list, it now has a chance to bring you back as just about anything in the game. It seems reasonable that the High Librarian of the Elves would decide not to respond to the Reincarnate spell if it would mean coming back in the body of, say, an orangutan.
As for the others: maybe the absolute highest high priest of the most popular religion in the world is high enough level to cast Raise Dead. One guy in the world, aside from any PCs that might happen to get that high. If the king has donated a heck of a lot of money to the Church of Pelor, maybe the high priest will deign to bring him back. Maybe.
This obviously doesn’t work so well for level 10+ games, though.
I also threw on a rule that every time you get resurrected, your body ages (1d20 minus your CON modifier) years. In games where resurrection is common, this makes death a little bit more than a slap on the wrist, in the sense that aging is more permanent than level loss. Unless you get reincarnated into a new body, of course, which always starts out Young Adult (plus 1d20-CON years, if you’re in my game).
I added some of these to my house rules and also using the Calibrating Your Expectations there will less access to raise dead just as malmar said. Although I am going to try one other thing:
Raise dead spells are one time use per character. Like a deal with the gods for one more chance. The character casting the spell can only use the spell once per level or sacrifice 1000xp per level of the character resurrected.
(I also might add an aging effect like malmar this way if a character gets high enough level to raise dead they wont like using it and can only do so on each friend only once.)
Super late posting, I know… but I guess thread necromancy is appropriate here.
Why not just use good old resurrection survival rolls? Blow one, and you need a wish or direct divine intervention.
Pathfinder’s revision to death & dying (and the disabled condition) is very much in line with what you’re trying to do; I completely agree with your analysis of level-to-death risk and the 0hp-only disabled condition. I also agree with your view on raising the dead, though I think I’d prefer to either move those spells to higher levels, make them unreliable (e.g. % chance failure), or some combination: maybe disallow _raise dead_, give _resurrection_ a % failure, and leave _true resurrection_ as is. You’re also right on about decoupling dying from unconsciousness: how many times have we read/seen a character spend minutes, or even hours in the dying condition while still conscious? Perhaps instead of: massive damage = death, massive damage = unconscious, save to be disabled?
Not sure how to link here, so here’s the URL for PF OGC rules on death, dying, etc. :http://www.d20pfsrd.com/gamemastering/conditions#TOC-Dead
I like these rules but haven’t used them in actual play, so I’m curious as to how well the fortitude saves vs unconsciousness scale into higher levels. My instinct is that total health (and thus maximum negative health) increases much faster than save bonuses, so you’d run into the opposite of the problem that the standard rules provide: instead of everybody going straight from “healthy” to “dead” with nobody ever falling unconscious, the DC 50+ checks would mean that nobody ever gets killed outright in battle, they just fall unconscious and bleed to death a few minutes later if their side lost.
Is that an issue that comes up, or am I just eyeballing the math wrong? (The UA rules for injuries-instead-of-hp divides damage by 5 to get what you add to the dc, maybe something like that is in order?)
Implementing the Alexander Rule (https://thealexandrian.net/wordpress/4021/roleplaying-games/alexanders-rule) to say I’ve been using these rules for several years now. Group generally agrees it’s a net positive. Have also begun to look into implementing Three Clues and your hexcrawl series. Thank you much for your hard work.
Question that has come up, actually: I would swear once upon a bye that I read here that the like of [i]restoration[/i] heals the hit point damage of any Constitution damage they heal. Is there any mitigation there, or does healing Constitution damage still leave the healee with buckets of lost hit points?
IMO, Restoration does not heal hit point damage — but it doesn’t need to. Constitution damage doesn’t inflict hit point damage, it lowers your maximum hit points so that whatever hit point damage you’ve taken brings you closer to being disabled or dead.
I know most people just track hit points, but I think what you really should be doing is tracking *damage*. Hit points rarely change, damage changes often. What do you do to differentiate between lethal and nonlethal damage? Clearly those are two different flavors of damage that can’t be independently tracked by merely subtracting from a hit point total.
By doing this, when you take Con damage your max hit points go down, and you have to check to see if your current damage equals or exceeds your hit points. Later when you get the Con damage restored, your max hit points goes back up and you are out of danger. If you have taken no damage, and then lose Con, you still haven’t taken any damage — you’re closer to death because you have fewer hit points. If your Con is restored and you still haven’t taken damage, then you are back to full health.
The rules don’t come out and explicitly say this, unfortunately, but I think it’s pretty clearly implied.
I’ve been thinking about using these houserules for my upcoming campaign, and am wondering what the motivation was for maximizing magical healing? Is this meant to apply only to disabled characters (as might be implied by its presence in an article on death and dying) or across-the-board?
I’m about to start up a new game which will be using a slightly-tweaked version of these rules as well. Justin would have to speak to his motivations, obviously, but I suspect it’s to remove the uncertainty about “just how many cure spells do I need to expend to heal X damage?” Also, having a healer spend an action to cast a cure spell and getting a minimum result is — well, it’s not quite a wasted action, but it can feel pretty close to that, especially at low levels. A CL 1 cure light wounds spell heals between 2 and 9 hit points — that’s a big swing. At higher levels things start to balance out as you start rolling more dice and the CL contribution increases in proportion to the dice result.
Maximizing healing spells is another way to mitigate the short adventuring day problem, too — this way the party is less likely to cut a sortie short because they expended all their healing early.
If you don’t want to maximize healing but still want more predictability, you could rule that the spells always heal the expected amount (4.5 points per die, rounded down).
I would not consider those rules STRONGLY tied to the rest of the house rules.
1. Using static values for healing was put in as a house rule primarily because endlessly rolling charges of a wand of cure light wounds was boring.
2. Boosting it from average value to max value was done mostly from gut back around 2001 or 2002, but I’ve never regretted it. I don’t know if it would work well in a normal game, but because these house rules let mid-level characters go deeply negative with their hit points, I think there’s somewhat of a balancing factor.
Also what Leland said about lengthening the adventuring day.
I really like these rules, and will plan on using them in my campaigns. I particularly like that you have resurrection as possible, but only for a short time. I’d been considering tweaks to the death and dying rules myself, and that feel is exactly what I’d been aiming for.
One thing I was wondering about: According to this rule, a “dead” character loses one hp per round if he doesn’t get a gentle repose spell. That’s ten hp/minute, so after even an hour a “dead” character will have lost so many hit points as to be essentially impossible to raise. So why did you give a 24-hour threshold on raising the dead? Or am I misreading the rules on “dead” characters.
How do you feel about the 5E death rules? I think the death save system solves some of the issues you had, but others remain. Do you play it as written or do you have a new set of house rules?
Generally a fan of the death saves system. Haven’t house ruled it in any of my 5E games.
I have become rather fond of the “scrambling to get massive amounts of healing within 24 hours” dynamic in my 3rd Edition campaigns and some of the cool stuff that spins out from that in terms of resource management. Also the “fighting on while dying” stuff is nicely dramatic. But 5E gets the job done.
>One problem I haven’t solved yet is the problem of unconsciousness. More specifically, the problem of waking someone up who has been unconscious.
>In real life, if someone gets knocked unconscious you can frequently (but not always) wake them up again by slapping them, throwing water in their face, or waving smelling salts under their nose. In the game, however, this doesn’t work. If you’ve hurt someone enough to knock them unconscious, the only thing you can do is either (a) magically heal them or (b) wait a very long time for them to naturally heal some damage.
To me it seems the issue is that there’s an unmodelled state of unconsciousness – the temporary unconsciousness caused by a concussive blow (or perhaps some grappling lock) below lethal threshold. In real life this typically lasts a few seconds to a few minutes and is caused either by an often-dangerous impact to the head or a full-body blow of significant force (e.g. explosion, occasionally a powerful strike or tackle).
In fiction a chief purpose of combat unconsciousness is to allow heroes to incapacitate mooks with ease (which ‘solves’ a problem that’s been noted before; most RPGs are good at killing but not at incapacitating; the house rules can help that too, of course). So then this is of course typically all of:
– easily inflicted (one punch likely to cause it, any blow to the back of the head it’s guaranteed)
– never lethal
– of long duration
– people recover fully after shaking their head a few times (rather than the lights going out for a few seconds before the person picks themself back up, maybe with a week-long concussion).
So if one wanted to add this, one could model this by saying that blows to an unprotected head or all-body blows cause a save against a DC determined by the amount of damage relative to character HP to avoid becoming unconscious; repeat save each round to recover consciousness (maybe every 2d6 rounds if using the fictional mechanic), and then on the recovery if it wasn’t by a good margin the individual might be in a groggy state for d100 turns. But at no point is this class of unconsciousness causing a loss of hp per round. Then using smelling salts, bucket of water, light slaps around the face could just lower the ‘recovery’ DC.
It could be a dangerous mechanic in that it potentially offers a much easier way of disabling people by at least partly bypassing the ablative system. Insert ‘please wear appropriate safety headgear’ sign here. For some game types this sounds like a version of this might be useful for increasing the options for nonlethal combat, especially if the rules modelled the fictional effects more closely than reality.