Mark a win for Level Up A5E in the death and dying rules. Every time you are dropped to zero hit points, you gain a level of fatigue. You get seven of those and are toast (gaining the doomed condition). In addition, fatigue levels introduce penalties that become more and more severe as they are gained.
Simple, clean, and puts a cost on zero hit points.
Tales of the Valiant and the 5E SRD go soft on this, with no levels of fatigue gained. I don't like this since it encourages "popup healing," and there is no cost to getting knocked unconscious. I hope the ToV GM Guide (or even the core rulebook) adds some options for a more realistic death-and-dying system. I bet ToV did this to maximize compatibility.
A5E introduces a strife system alongside fatigue, which handles mental stress and is an elegant solution to the insanity problem. Also, these conditions are not regained quickly. A haven (safe spot) is needed to recover from a single point of strife and fatigue during a long rest. With a safe place, the first level of strife and fatigue can be recovered - and none others.
So if you have five fatigue levels without a safe spot to rest in, you are not regaining any of them.
The 5E SRD and current ToV Alpha have no mention of fatigue. Check another box where the SRD is missing rules.
Survival-based 5E games? I would use A5E exclusively here, the game has an amazing exploration and survival pillar. The strife rules let you run horror effectively.
A clear win for A5E.
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