Call of Cthulhu 7e Damage, Hit Points, and Major Wounds Guide

Introduction

Damage in Call of Cthulhu 7e tracks how close an ordinary person is to being unable to go on, rather than draining a hero's large pool of health. A few points can matter, one hard blow can matter far more, and armor can turn a disastrous hit into a painful but survivable one. Once a hit crosses the Major Wound line, the game stops treating the fight as an obstacle and starts treating it as a consequence, with a clear clock attached.

This guide follows an injury from start to finish: the damage sequence, maximum and current hit points, armor, the Major Wound threshold, the three meanings of zero hit points, dying and stabilization, First Aid and Medicine, and recovery over the following weeks. For the wider survival mindset and the attack procedure itself, see the Combat and Chases hub.

Hot Take

Armor does not mean you can stand in the doorway trading blows, and a conscious investigator with a Major Wound should not be taking another swing. Both buy one more decision. The best Major Wound scene is the one where the group finally says what matters (the evidence, the witness, the wounded friend, or the way out) and uses that decision to get behind something solid or leave the building before the next roll takes the choice away.

Damage Is the Clock

When an attack succeeds, damage tells the table more than how hurt someone is. It shows whether the problem has become a medical one, whether a combatant can keep chasing the objective, and whether everyone needs a new plan. The numbers are small enough to read at a glance.

Keep three questions separate:

1. How much damage did the successful attack produce?
2. How much of it did armor stop?
3. What does the remainder mean against this target's maximum and current hit points?

Order matters. Do not announce a Major Wound from the raw weapon roll and remember the helmet afterward. Armor reduces the damage that passes through it, and what remains changes hit points and drives the Major Wound check.

The fiction should move with the math. The Keeper Rulebook asks for injuries that fit the damage (shot in one arm, a sprained ankle, a lump on the back of the skull) rather than "you lose 3 hit points." A small result might be a glancing blow, a lost breath, or a cut that makes a grip unreliable. A larger one might end an investigator's ability to stay in the room. Practical consequences are often the most unsettling: the key falls, the flashlight breaks, the witness is alone at the car, or the stairs suddenly look very far away.

Damage Bonus Is Part of the Attack

Some investigators and foes add a damage bonus to physical attacks. Add it to the damage before armor applies. A hard hitter can cross a serious threshold with an ordinary weapon, while a smaller investigator has more reason to rely on position, a maneuver, or an escape route. On an Extreme success made on the attacker's own turn, the attack deals maximum weapon damage plus maximum damage bonus, and an impaling weapon adds another weapon damage roll on top.

Damage bonus is still only one input. Cover, surprise, a prepared exit, the right tool, a better goal, and a steady companion can be worth more than a few extra points. Call of Cthulhu rewards the investigator who makes the scene less dangerous before rolling.

Maximum Hit Points and Current Hit Points

Maximum hit points come from CON and SIZ: add them, divide by 10, and round down. This number is the reference for the Major Wound threshold and for recovery, so write it where everyone can see it.

Current hit points are what the investigator has left right now. Mark damage off as it happens. The gap between the two numbers is useful information: a character at full hit points can take a risk that an equally skilled character at 2 hit points should turn down.

Example: Vera has CON 60 and SIZ 55, so her maximum is 11. After taking 4 damage she has 7 current hit points, but her Major Wound check still uses 11. A single attack dealing 5 after armor is regular damage, since 5 is less than half of 11. A single attack dealing 6 after armor is a Major Wound, since 6 is at least half of 11.

Do not add separate hits together to find a Major Wound. Two hits of 3 damage each are not one 6-point attack. They can still leave Vera in serious trouble as her current hit points shrink, but the Major Wound rule only looks at the damage from one attack.

Keep Both Numbers Visible

Tracking current and maximum separately prevents two common mistakes:

• Treating a character at low current hit points as if a small hit automatically caused a Major Wound.
• Forgetting that a barely scratched investigator can still take a Major Wound from one strong hit.

The Keeper benefits too. A glance at an investigator's maximum shows what a dangerous opponent can do in one blow. That is not a reason to shield players from consequences. It is a reason to describe danger honestly, offer readable exits, and avoid presenting a fair-looking brawl when a single success could drop someone.

Resolve Damage in This Order

Use this sequence whenever an attack or hazard deals damage:

1. Confirm the hit and calculate full damage, including damage bonus and any Extreme or impale result.
2. Subtract armor that actually covers the attack.
3. Subtract the remainder from current hit points.
4. Compare that one result to half the target's maximum hit points, then to the full maximum.
5. Apply the result: regular damage, Major Wound, zero hit points, or death.
6. Describe what changed and ask what everyone does now.

At the table this is quick. The discipline is pausing at step four. A player who hears "you take six" may not notice that six is exactly half their maximum, and a Keeper who jumps straight to narration may forget armor or the zero-hit-point distinction.

Example, the coat matters: Dr. Inez has 12 maximum hit points and a heavy leather coat worth 1 point of armor. A club deals 7 damage. The coat cuts it to 6, so she loses 6 hit points. Six is exactly half of 12, so it is a Major Wound. Without the coat she would have taken 7 and still suffered a Major Wound, so the coat did not make the moment harmless. It did keep one more hit point on her sheet, and that point can decide whether a later scratch drops her to zero, whether she can be moved safely, or whether the group has time to leave.

Regular Damage Still Changes the Scene

Regular damage is damage from a single attack that is less than half the target's maximum hit points. Mark it and describe it. The label only means the hit did not cross the Major Wound threshold.

By the rules, regular damage has no significant effect until current hit points reach zero. That does not mean the character feels nothing. A player can play a bruised hand as making a lockpicking attempt nerve-racking, and a Keeper can describe a torn sleeve and ragged breathing. Just do not invent penalties the rules do not impose; the shrinking total already creates pressure.

A character cannot die from regular damage alone. If a character reaches zero without a Major Wound, they are unconscious, not dying. The situation is still urgent in an unsafe place, but a pile of small hits should not become an accidental death sentence.

Example, several bad hits are not one catastrophe: Marcus has 10 maximum hit points and no Major Wound. In a frantic struggle he takes 3, then 3, then 4. Each hit is under half of 10, so each is regular damage. The last one takes him to zero, and he falls unconscious, but he is not dying. Someone still has to get him out of the collapsing basement, keep the enemy off, and deal with the evidence. The group is rescuing an unconscious ally, not making death rolls because the math happened to reach 10.

Armor Is Useful, Narrow, and Worth Tracking

Armor can be worn protection, a monster's hide, or a solid obstacle between attacker and target. Subtract its points from any attack that passes through it. The rulebook's examples run from a heavy leather jacket at 1 point and a WWI helmet at 2, through a heavy Kevlar vest at 8, up to a large sandbag at 20. In a 1920s game, most investigators have little or no armor, which makes every point worth remembering.

Armor is not universal damage reduction. It does not reduce damage from magical attacks, poison, drowning, and similar harm. Before subtracting, ask one fictional question: did this protection plausibly stand between the investigator and this harm?

That question keeps a coat or vest from becoming a plot shield. Protection helps against a physical strike it covers. It does nothing against smoke, a collapsing floor, a toxin, a spell, or whatever waits in the black water under the pier.

Armor Is a Reason to Plan, Not Linger

Players should mention protection before damage is rolled, or as soon as a hit is resolved, not after seeing whether the number is scary. The Keeper settles what a piece of protection covers once and moves on. Repeated arguments over whether a garment "counts" drain a scene faster than a missed punch.

Give a protected investigator jobs that use the margin responsibly: hold a door while others leave, cross a short exposed stretch to grab something, or cover a retreat. Do not make them the designated target for everything. The next danger may be one armor cannot touch.

Major Wounds

A Major Wound happens when a single attack deals damage, after armor, equal to or greater than half the victim's maximum hit points. The rulebook puts the difference plainly: someone beaten unconscious by a series of punches may wake up bruised but able to act the next day, while someone who takes the same total from one gunshot may be out for a week or more before healing even starts.

The marker matters because it changes what zero means. With only regular damage, zero is unconsciousness. With a Major Wound, zero is dying. Every player should know that line before deciding whether to stay in the room.

This is not a delayed penalty for being low. A nearly healthy character can take a Major Wound; a character barely standing can avoid one if the next hit is small. The danger is severe but readable.

Once the box is ticked, the group should reassess. The original objective may still matter, but it now competes with keeping the wounded investigator alive and getting them somewhere safer. Sometimes the answer is to finish one action. Often it is to leave now.

What Happens Immediately

When an investigator takes a Major Wound, resolve these in order:

1. Tick the Major Wound box.
2. The investigator falls prone.
3. Roll CON to stay conscious.
4. If current hit points are now zero, the investigator is dying (see below).

The injury has already happened by the time the CON roll comes up. The roll decides whether the investigator stays conscious enough to act. A failure means unconsciousness even with hit points left. A character holding someone in a grapple loses that hold when they take a Major Wound.

Being prone matters. A prone investigator may be exposed, hard to move, or unable to reach something, or may suddenly have low cover behind furniture. Ask where they land. Falling behind a desk leads to a different next choice than falling in the middle of a warehouse floor.

Example, one last necessary action: Elias has 14 maximum hit points and takes 7 damage after armor from one attack. That is a Major Wound. He falls prone, passes his CON roll, and still has hit points, so he is conscious and not dying. He can act on his turn, but the situation is not normal. His best move might be to slide the photograph under the office door, shout the suspect's name to the others, or crawl behind the filing cabinet while a companion gets the car.

Conscious Does Not Mean Safe

The rules let a conscious investigator with a Major Wound keep acting. Use that carefully. The character does not have to pretend nothing happened, and the Keeper should not pile on extra penalties because the injury sounds bad. The ticked box and the threat of zero already provide the pressure.

For players, this is a chance to make the next action count: direct an ally, secure a key clue, throw a switch, lock a door, use a maneuver to make space, or reach cover. Trading more attacks is usually the least useful option unless that one action opens the escape.

For Keepers, make the terrain clear. Say where the exit is, whether there is cover, what an ally can reach, and what the threat is doing. A Major Wound is dramatic because players can see hard options, not because the route to safety is hidden.

An unconscious investigator is not gone from the story. The player can contribute through a brief flashback, point out something their character was carrying, or work with the Keeper on recovery and consequences. Meanwhile the others need a concrete problem: "Mara is out, the alley is open for one round, and the cab is fifty feet away."

Zero Hit Points Is Not One Outcome

At zero hit points, stop tracking. Do not record negative numbers. The character is unconscious. Further damage is generally ignored, but a sincere attempt to kill an unconscious person succeeds.

What happens next depends on how they got there:

• Zero from regular damage only: Unconscious, and will heal in time. Regular damage alone cannot kill.
• Zero with a Major Wound ticked: Dying, and will soon die without First Aid.
• One attack dealing more than maximum hit points: Death is inevitable.

The rulebook calls this a triage model. Do not collapse all three into "zero means dead," and do not soften the third case into another chance for treatment. The distinction makes a gunshot, a crushing impact, or a monster's strength feel different from a hard but survivable beating.

Some harm ignores this structure. For drowning and suffocation, the rulebook has the victim roll CON each round; after the first failure they take damage every round until they can breathe, and death comes at zero hit points without regard to the Major Wound rule.

Dying and Stabilization

Dying is the most urgent state in the game, and the procedure is precise. Run it exactly: no vague "you have a little time," and no extra rolls beyond what the rules call for.

Dying Is a Round-by-Round Clock

A character is dying when their hit points reach zero and they have a Major Wound. Record current hit points as 0, tick the Dying box, and the character falls unconscious immediately.

At the end of the next round, the player rolls CON, and again at the end of every round after that. The first failed roll means immediate death. A success buys one more round, not safety.

This is why the group should see the danger before the character drops. A player who takes a Major Wound and stays conscious has time to call for help or move toward an exit, and companions can decide who handles First Aid, who holds the threat back, and who gets the car.

Example, the clock starts: Jun already has a Major Wound from an earlier gunshot. Later in the same fight, a smaller hit drops Jun to zero. That second hit does not need to be a Major Wound; the ticked box is enough, so Jun is dying and unconscious. A companion attempts First Aid during the round. If it fails, Jun still rolls CON at the end of the round, and a success gives the group one more round to try. State the timing plainly: who is treating Jun, who is making space, and what happens if nobody succeeds.

Put a token or note in the turn order so the end-of-round roll is not forgotten. Keep declarations short so the dying player is not waiting through a long tactical debate: "I use First Aid." "I drag Jun behind the crates." "I fire once to push the cultist back, then retreat."

First Aid: Stabilize Now

First Aid is the emergency skill. For ordinary injuries it must be applied within one hour, and it restores 1 hit point. It can be attempted once, and further attempts count as pushed rolls. Two people can work together, and the treatment works if either succeeds. A successful First Aid roll can also wake an unconscious person. Treating a fellow human is always Regular difficulty; unfamiliar alien physiology is harder.

Dying is the key exception. Only First Aid can stabilize a dying character; Medicine cannot do it first. A successful roll stabilizes the patient for one hour and grants 1 temporary hit point. From then on, the CON roll moves from every round to the end of each hour.

If First Aid fails on a dying patient, it can be tried again on a later round (by up to two people) without counting as a pushed roll, until the patient is stabilized or dead. This is the emergency procedure for a group facing a dying companion, not a loophole for endless rolls in a calm room.

The temporary hit point does not mean the investigator is back in the fight. Treat it as a narrow window for evacuation to a car, hospital, trusted doctor, or at least a safe place where Medicine can be tried. At the end of each hour the stabilized patient rolls CON. A success holds for another hour. A failure means they lose the temporary hit point, go back to dying, need First Aid again, and resume rolling CON every round. If the group is far from help, that creates a clear campaign clock.

Medicine: Out of Immediate Danger

Medicine treats injuries rather than buying moments. It takes at least one hour and can be applied any time after the damage, but if it is not done the same day, it needs a Hard success. A successful roll restores 1D3 hit points on top of any First Aid. Successful Medicine can also wake an unconscious person.

For a dying patient the order is fixed: First Aid to stabilize, then Medicine. When Medicine succeeds, untick Dying and add 1D3 hit points. The Major Wound box stays ticked, so the investigator is no longer dying but has not recovered from the serious injury.

A character normally gets only one successful First Aid and one successful Medicine treatment until they take more damage. That stops a party from turning a quiet afternoon into unlimited healing. The repeated-stabilization exception applies only to dying patients.

Example, from alley to hospital: After First Aid stabilizes Jun, the group gets Jun into the back of the car and drives to a hospital. After at least an hour, the doctor succeeds at Medicine. Jun's Dying box is cleared and Jun gains 1D3 hit points, but the Major Wound remains. Now the question is whether the investigation can wait. The cult may be holding its ritual tomorrow, or the only witness may be leaving town. The others may have to go on without Jun or decide the case cannot be finished without them.

Recovery and Healing

Recovery turns an injury into a campaign cost. It should take a few minutes of table time and leave the next session with more texture, not a week of clinical narration.

Regular Damage Recovery

If the Major Wound box is not ticked, a character recovers 1 hit point per day. The rulebook's example is an investigator with 15 hit points knocked to zero by three regular hits: he is back to full after 15 days.

Major Wound Recovery Week by Week

While the Major Wound box is ticked, the character rolls CON at the end of each week of game time. This is separate from the CON roll to stay conscious and the CON rolls for dying.

• Failure: No hit points recovered that week.
• Success: Recover 1D3 hit points.
• Extreme success: Recover 2D3 hit points and erase the Major Wound.
• Fumble: A lasting injury, complication, or worse condition results.

Complete rest in a comfortable place grants a bonus die. Effective medical care grants another: the caregiver with the highest Medicine skill rolls once at the end of the week, before the patient's CON roll, and a success provides the bonus die. A poor environment, too little rest, or a fumbled Medicine roll by the doctor or nurse imposes a penalty die.

These modifiers show what recovery costs. A hospital bed, a reliable nurse, and a quiet week improve the odds. Sleeping in a damp ruin, riding a train all night, or going back to fieldwork early makes recovery harder. Players can choose urgency, but they should see the price.

Example: In the rulebook, Harvey spends his first week in hospital with the best care and full rest, rolls with two bonus dice, and recovers 3 hit points. The next week he does light work at home with no care and recovers nothing. In the third week he rests in bed while a nurse checks on him, rolls with two bonus dice again, gets an Extreme success, recovers 5 hit points, and erases the Major Wound. From there he heals 1 point a day.

Erasing the Major Wound Marker

There are two ways to clear the marker:

1. Roll an Extreme success on a weekly recovery roll.
2. Recover current hit points to at least half the character's maximum.

After that, any remaining damage heals at the regular rate of 1 hit point per day. A character can gain a few points from Medicine and still need weekly rolls because the marker is still ticked.

Watch for the moment hit points cross half the maximum. If healing from Medicine gets there, the marker is gone without waiting for the weekly roll. Do not clear the box just because the investigator feels better in the story; it stays until one of those two things happens.

Lasting Injuries and Story Consequences

On a fumbled weekly recovery roll, the rulebook encourages the Keeper to pick a consequence that fits the injury rather than roll randomly: a permanent limp, blindness in one eye, missing fingers, a lost limb, or a scarred face. Record it in the investigator's backstory under Wounds and Scars. In the rulebook's jungle example, an infected bite means someone may have to attempt an amputation.

This is not a license to strip a character of usefulness without warning. Talk the fiction through with the player, especially for permanent results. A scar can become an identifying feature, an old injury can shape how a character approaches a particular danger, and a complication can lead straight to a doctor, a clinic, or a desperate favor. Match the description to the group's agreed horror boundaries; the mechanics stay the same.

Environmental Damage Uses the Same Questions

Damage does not only come from weapons. Falls, fire, collapsing masonry, moving vehicles, and exposure use the same sequence: set the damage, apply protection if relevant, reduce hit points, and compare the single result to maximum hit points.

For harm with no listed number, the rulebook gives a severity scale. Minor harm (a punch, a fall onto soft ground) is 1D3. Moderate harm that might cause a Major Wound is 1D6. Severe harm likely to cause one is 1D10. Deadly harm is 2D10, terminal harm is 4D10, and harm where death is almost certain is 8D10. Each rating covers one incident or one round, so someone who stays in a fire keeps taking damage each round they are exposed.

The Keeper should signal environmental danger before rolling: the rotten stair, the thickening smoke, the loose beam, the slick roof, the gap too wide to jump casually. Hazards matter when players can choose around them. Unavoidable damage has its place for shock, but it should be the exception.

Players can use the same logic in reverse. If the threat can be slowed by a falling door, a burning curtain, a locked gate, or a bad floor, the group may be able to delay it without trying to out-damage it.

Player Guidance

• Treat current hit points as planning data. At full health, you might risk unlocking a car under fire. At 2 hit points, the same action needs cover, help, or another route. Say so: "I'm at two; I'm not holding that door alone."
• Know whether your Major Wound box is ticked, and say so. It tells everyone that hitting zero is now a different emergency. If you are still conscious, use your next turn to improve the group's position.
• Use armor narrowly. Know its value, say what it covers, and plan as if it may not help with the next threat. A vest does nothing against poison.
• Keep First Aid in the group. It is the only skill that can stabilize a dying investigator. Before a dangerous scene, decide who has it and who protects the medic.
• Reassign roles when someone drops. One person secures an exit, one gets the injured investigator moving or sheltered, and one handles the threat only as long as needed. The objective has probably changed.
• Treat rest as a resource. A hospital, safe house, or trusted doctor can matter as much as a weapon. If the group cannot rest, say out loud that the case is trading health for time.

Useful questions before and during a fight:

• "What damage can this protection actually reduce?"
• "How much does one more ordinary hit change our options?"
• "If this is a Major Wound, who gets us out?"
• "Is the evidence worth staying for once someone drops?"

Keeper Guidance

• Announce thresholds and state changes plainly. "Six after armor; that's half your maximum, so tick Major Wound. You're prone. Roll CON." If hit points hit zero: "You're dying. Your first CON roll is at the end of next round." Clear procedure makes the pressure fair.
• Rule on armor consistently. Establish once what a piece of protection blocks. If a danger bypasses it, explain why in one sentence and move on.
• Give injured investigators real but bounded agency. A conscious wounded character can warn the group, choose the route, or hand off evidence. An unconscious one makes the rest of the table confront its priorities. Do not use injury to sideline a player for a long fight.
• Put care and rest in the world. Hospitals, sympathetic doctors, safe rooms, and transport should exist, with costs and obligations attached. A Major Wound is compelling when the group chooses how to survive it.
• Use recovery fumbles to deepen the story. Tie complications to the place, the enemy, or the case, and discuss permanent results before imposing them.
• Build exits into dangerous places. A fire escape, a service door, a boat at the dock, or an ally with a car gives the damage rules their purpose: forcing the group to choose what to save.

Damage, Wounds, and Recovery Checklist

Before a dangerous scene:

• Record maximum and current hit points separately for each investigator.
• Note any armor and what it plausibly protects against.
• Know who has First Aid and Medicine, and where the nearest care is.
• Identify an exit, cover, or a way to move an unconscious ally.

When damage lands:

• Calculate full damage, including damage bonus and any Extreme or impale result.
• Subtract applicable armor, then subtract the rest from current hit points.
• Compare that single result to half and then all of maximum hit points.
• On a Major Wound: tick the box, place the investigator prone, and roll CON to stay conscious.
• At zero: decide whether the cause was regular damage, a Major Wound, or one overwhelming attack.

When an investigator is dying:

• Record 0 hit points, tick Dying, and roll CON at the end of each round.
• Use First Aid to stabilize (1 temporary hit point, CON each hour); retry on later rounds if it fails.
• Follow with successful Medicine to clear Dying and restore 1D3 hit points.

During recovery:

• Heal 1 hit point per day if no Major Wound is ticked.
• Otherwise roll CON weekly, with bonus dice for rest and successful medical care and penalty dice for poor conditions.
• Recover 1D3 on a success or 2D3 on an Extreme success.
• Erase the Major Wound on an Extreme success or once hit points reach half the maximum.
• Turn a recovery fumble into a fitting, agreed consequence recorded under Wounds and Scars.