Earning your character’s First Aid merit badge

Back in my B/X D&D days, we had a house rule that said when you got to zero hit points, you were knocked out and dying at the rate of 1hp per round, but you weren’t dead until you reached negative hit points equal to your Level + CON bonus. If someone could “bind your wounds” before that point, you’d stop losing hit points (continued "binding" could restore 1 negative hit point per round until you returned from the brink of death).

I wanted to incorporate that concept into Chimera, and kept thinking of what “binding your wounds,” really meant. From my Boy Scout days, that pretty much meant first aid: treating for shock, stopping bleeding, applying bandages, splints, slings, knowing how to handle an EpiPen, and occasionally sucking snake venom out of your buddy’s leg.

First aid is all about stablising a patient with immediate care until more comprehensive medical treatment can be provided. Not unlike what adventurers have to do: Regardless of your setting, “comprehensive medical treatment” is rarely available in the field. And this is where first aid and healing--as it’s interpreted in most RPGs--part ways.

I'm Not A Real Doctor...

At a basic level, first aid is temporary field treatment, while healing is permanent hospital treatment. Think of it this way: first aid is what Aragorn gives Frodo at Weathertop. Healing is what Elrond gives to Frodo at Rivendell. In other words, first aid is enough to make an injury bearable or keep a patient alive until healing can actually fix the damage.

How you simulate this in your game depends on how your game represents wounds. In Chimera, each wound you suffer imposes a cumulative, overall penalty of -1 (i.e., you take 3 wounds, you operate at -3). When you heal a wound, the penalty abates; when all your wounds are healed, the penalty goes away.

This approach lets you simulate first aid’s temporary effect by addressing the penalty, but it ignores the actual wound. In Chimera, then, a successful First Aid roll reduces a patient’s wound penalty by -1 for a number of hours equal to the first-aider’s level. If the wound isn’t actually healed within that time, the penalty returns.

If your system uses hit points, first aid attempts might restore 1hp per rank in the first aid skill, though it would last only 1 hour per level. Or something along those lines. Basically, you want minimal restoration for a limited duration--just enough to keep the character going until he can get proper treatment.

And proper treatment requires full-scale medical facilities: a field hospital, a monastery, a clinic, a doctor’s office, an emergency room, a hospital ship, maybe even or Bethesda Naval Medical Center. By extension, healing also requires more training than first aid, so while any character can “bind your wounds,” actual healing requires a professional.

...But I Play One On Friday Nights

This approach makes the healing profession stand out a bit more. A combat medic can apply a good amount of ditch medicine in the field, but proper healing requires the medical droid back on the dropship. Of course, this approach makes the party cleric (or anyone else with healing magic or medical tech) truly valuable, because you're basically saying that as long as PCs are in the field, any damage they sustain is more or less permanent until they return to their home base.

There’s also a reverse benefit, though, because now you can allow your campaign’s “non-healers” access to first aid without unbalancing their role. Fighters, rogues, and other physical types--regardless of setting--naturally possess rudimentary first aid knowledge, just by virtue of fixing the cuts, bruises, and sprains they receive as they train. Magic-users and scholars get first aid knowledge because of the broad scope of their learning--even though they may insist on using leeches in their ministrations. Priestly types get first aid skill for much the same reason, but now you can decouple them from the default role of “healer” (which makes sense if the cleric’s deity has nothing to do with healing or if the cleric’s alignment makes him stingy about who he heals with his spells).

Now that you’ve opened up first aid ability to all characters, you’re increasing party survivability (or, at least, you’re fending off the TPK because characters have more restorative flexibility). At the same time, you’re also increasing the worth and benefit of actual healing sources in the field (i.e., during the adventure): magical potions of healing, restorative gel-caps, remote surgery bots, Med-suits, a working bacta tank found in the mad scientist’s lair, all have vastly increased value.

If these are appealing options, I suggest you replace your system’s Heal skill with First Aid. You can go a step further by adding a Professional skill for Physicians. That way, your characters can perform first aid during an adventure with a First Aid roll, but full-on healing is accomplished by an actual doctor (with access to actual medical facilities).

What Else First Aid Can Do

While I’m on the subject, here are some things you can do with a successful First Aid skill roll:

• Temporary Relief: Reduce patient’s wound penalty by -1 for 1 hour/level (if your system uses hit points, a successful First Aid roll restores 1hp/skill rank for 1 hour/level)
• Neutralise Poison: Stave off the effects of venom for 1 round per level or skill rank
• Revive: Awaken an unconscious character, or snap a stunned character out of his stupor
• Refresh: Negate fatigue-related penalty by -1

Final Words

By separating first aid from actual healing, you end up providing more survivability options to PCs without unbalancing the game. The side benefits include making healing more valuable as a service and healers more important as practioners. While much of this appeals to my sense of realism, my own experience confirms that it’s highly playable.

It’s a lot to consider--is this something that would work in your game?