5e D&D Rules Modifications: Wounds

One common complaint about Dungeons and Dragons is tht for the most part your character are as effective at full health as they are with one HP left. This detracts from the sense of verisimilitude in the game, and it tends to make retreat less likely for both PCs and NPCs. If, as you are injured, you become less effective, the reasoning goes, you are more likely not to fight to the death. The problem is that D&D is a game that isn’t designed to track wounds, so systems that add this to D&D tend to be a bit clunky and not work with the rules. I’m in favor of minimum viable system for rules changes, especially for games as complicated as D&D.
Here is my attempt to use a mechanic that is already present in 5e to make wounds a more impactful thing.

We will start with a little bit of (I promise) painless math, and a rule that is already part of 5th Edition, Exhaustion.

Wounds
The first thing is to take your character’s maximum HP and divide it by 4. Round that number up. This is your wound threshold. You will need to recalculate this number at each level, but only once per level.

Whenever a character takes damage greater than or equal to their wound threshold, they must make a DC 14 Constitution Saving throw. On a success, there is no further effect. On a failure, they gain a level of exhaustion. This exhaustion is stacks with exhaustion from other sources and it is cleared the same way that it is from other sources: a long rest or Greater Restoration spell remove one level of exhaustion, while the very rare potion of vitality can remove all levels of exhaustion. Accumulated exhaustion does not keep the character from healing through rest or magic.

Notice that, given an active day and a lot of healing magic, it is possible for a character to die of wound based exhaustion, and until a wounded character takes some time off to deal with those wounds, they will be less effective in a fight.
An alternate version sets the wound threshold at half of maximum hit points at first and second level, and a quarter at third on. (the wound threshold can not go down at third level. If the HP work out that way, use the previous level’s wound threshold.

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