A Primer on Hit Points and Healing in the new Dungeons

& Dragons
Although Ive written a lot about the various initiative systems in D&D, I could
quite easily fill a lot of space talking about how healing has changed through the
editions. For players moving from AD&D to 5E, the way healing works is likely to
be quite strange. Yes, you still have spells that allow you to heal, but why are Hit
Dice being used for healing? What are short and long rests?
The one thing that hasnt changed in the new D&D is that hit points measure how
long you can fight before falling unconscious (or dying). They represent a mix of
actual health and physical fitness, along with a component of luck, skill, divine
providence and fatigue.

As not every hit point lost represents an actual wound, characters can regain a
portion of their hit points by resting. Actually trying to determine when a wound is
real is very difficult, except in one occasion: when youre dead, that last one? It
was real!

Zero hit points and dying

Characters in D&D are either fine or they arent; a loss of hit points does not
degrade their fighting capabilities. Previous editions of D&D had the concept of
negative hit points if you were on 3 hit points and took 8 damage, you were on
-5 hit points and unconscious, and if your hit points hit a particular threshold (-10
in most editions), you died.

Thats not the way it works in the new edition. Instead, once you reach 0 hit
points, you cant lose any more. However, if the remaining damage (or new
damage) equals or exceeds your maximum hit points, you immediately die. Thats
one way of attaining instant death.

Once youre on 0 hit points, you must make a Death Saving Throw at the start of
each of your turns. On a 10+, you succeed. If you make three successful saves,
you are stable and just remain unconscious for 1d4 hours; after that you wake up
on 1 hit point. Unless youre hit again (when you need to start making saves
again) or get healed. Three failures on Death Saving Throws? You die. Try not to
let that happen!
 There are a couple of special cases worth noting with Death Saving Throws:

A natural 1 on the save counts as two failures.

A natural 20 on the save means you regain 1 hit point. As the saving throw
is made at the start of your turn, you can take the rest of your turn normally
(generally you pick up your weapon, stand up, and do something else).
In addition, if you take any damage while on 0 hit points, it immediately counts as
a failed saving throw. If the damage came from a critical hit, it counts as two failed
saving throws! (And when youre unconscious, any attack made from within 5 feet
of you that hits is automatically a critical hit!)

Note that Death Saving Throws are still saving throws, even if they dont have any
normal modifiers on the dice roll. Spells, feats and special abilities can affect
them. In particular, halflings get to reroll 1s due to their Lucky trait!

Also: While youre at 0 hit point, you cant benefit from a short or long rest. You
need to return to 1 hit point first!

Healing Spells:
Cure light wounds has been the primary way of healing characters since the
earliest days of D&D, but there was a gap in the spell list which meant it was the
only healing spell until the fourth level cure serious wound spell was achieved.
That gap was plugged in 2E. From that, we get the 5E spell Cure Wounds: it
heals damage proportional to the spell slot you use. It is cure light wounds, cure
moderate wounds, cure serious wounds, cure critical wounds and other spells we
hadnt even named all rolled into one. It has a bonus equal to your spellcasting
ability modifier on the hit points it heals.
Clerics who cant get to their companions may find the healing word spell of use.
It heals at range, but is only half as effective as cure wounds. However, it can be
cast as a bonus action, which means you can still fight or cast other spells in the
same round you use it. Swift healing at range was one of the best features of 4E,
and its good to see it here.
There are also versions of both spells which affect several characters at once.

Potions of Healing: Magic items are going to be almost impossible to buy in the
new D&D, with one exception: potions of healing. They cost 50 gp each, take an
action to drink or administer, and restore 2d4+2 hit points. They take longer to use
than in 4E, but theyre likely to be quite popular, although its uncertain as to how
rich characters will actually be treasure rewards dont seem to scale up as
much as in previous editions. Potions of healing are also coloured red, which
probably is a reference to their colour in some very popular computer games
Short Rests and Hit Dice: Characters in 4E could heal themselves from a pool
of healing surges each equal to a quarter of their hit points. A typical character
might have 8 of them available each day, and they were also expended by healing
magic (which would provide a bonus to the healing). Whenever a character took a
rest between combats, they could use healing surges to regain hit points.
Part of this idea remains in 5E, but with a couple of changes. First of all, theyre
called Hit Dice, and theyre equal to the number of dice you roll to determine your
hit points. Whenever you rest for an hour or more, you may expend as many Hit
Dice as you like, rolling them and adding the total to your current hit points. Your
constitution modifier applies to each hit die rolled.

A Short Rest is defined as being a period of 1 hour or more when you get a
chance to bind wounds and generally recover. There are several abilities
possessed by characters that also recharge when you take a short rest. Its a lot
longer than the time in 4E, so wont be as frequently employed.

It should be noted that healing surges and hit dice entered the game for two
reasons. The first is to allow players to adventure without a cleric (or other
healer). The second is due to the wand of cure light wounds in 3E. That wand
cost a negligible amount of gold, and had fifty charges of 1d8+1 healing each. As
a result, characters in 3E would typically be healed up to full after each fight. Hit
dice are a lot more limited than either what you get in either 3E or 4E.
Long Rests and Full Healing: If you rest for eight or more hours, you get the
benefit of a long rest: all your hit points are healed, and you regain half (rounded
down) of your hit dice. For those who are used to AD&D, this is a major change in
how the rules work. Without magic, itd take weeks for a badly wounded fighter to
get back on his feet! For those in 3E, its a change but they had wands of cure
light wounds so it didnt matter. For 4E players, this is less than they had, as they
got all of their healing surges back!
Long rests are also where you regain spell slots and some of the more powerful
class abilities.

To clarify how many Hit Dice you regain: it is half of your maximum Hit Dice,
rounded down, with a minimum of 1 Hit Dice regained. (And no, you cant regain
more Hit Dice than you have). So if you have 5 Hit Dice and have spent 3, you will
regain 2 Hit Dice with a long rest.
The minimum of 1 is confirmed in the errata to the Players Handbook.

Revivify: Although the classic spells of raise dead and resurrection are in the
game, there is a new 3rd level cleric spell that offers an earlier solution to
unfortunate death at low levels: Revivify brings back to life one character who
died if you can get to them within a minute. The first time I saw this spell was
during 3E, where you could only use it in reaction to someone actually dying.
As revivify only restores 1 hit point, they are quite vulnerable if a fireball should
strike them during the next round. This did, in fact, occur during my 3E Ruins of
Greyhawk campaign the only two times that character died in the combat were
the initial death in that combat, and then again after he was revivified! Use with
care!
Too much healing? Too little healing? Look in the DMG: The designers of the
new Dungeons & Dragons are well aware that the amount of healing and how it
works will not suit everyone; healing has changed a lot in the game over the
years. I fully expect that the Dungeon Masters Guide will have alternative
systems. (Mike Mearls has indicated that a Wound/Vitality system similar to the
d20 Star Wars system will be included). Even now, its pretty easy to eliminate hit
dice if you like, eliminate short rests, or make short rests only take 5 minutes.
Theyre just rules.
A System for Grittier Healing: One way you could make healing less effective
whilst still retaining most of the assumptions made by the 5E designers is to make
the healing you gain from Hit Dice and Second Wind into Temporary Hit Points.
(Temporary Hit Points dont stack, but its easy enough to make an exception for
these, or just say all hit dice you spend at one time go into one temporary HP
pool). If you add this to a rule that you dont recover all your hit points from a long
rest say, you recover half your level (minimum 1) in hit points for each full day of
rest, then you have a system where real wounds need magic or a lot of rest to
recover, but still allow you to refresh yourself and keep going until you have a
long rest, the temporary hit points go away, and you realise exactly how much
punishment youve taken!