Introduction
Persistent damage is the rule that turns "I got hit" into "I have a problem that is still happening." Fire keeps burning. Acid keeps eating. Bleed keeps bleeding. Poison keeps punishing Fortitude. The first hit matters, but the real danger is that the effect steals attention from future turns.
Use this guide with conditions, dying and death, afflictions, combat, Medicine, alchemical items, runes, hazards, and GM Core guidance.
Hot take: persistent damage is not scary because the number is big. It is scary because it makes the player spend the next turn asking whether they can afford to keep doing the fun thing.
Core Procedure
Persistent damage is a condition. It has an amount and a damage type, usually written like "1d6 persistent fire damage" or "2 persistent bleed damage."
| Step | What Happens |
|---|---|
| Gain the condition | The effect gives the target persistent damage, usually after a Strike, spell, hazard, item, or critical effect. |
| Wait until end of turn | The target does not take the persistent damage immediately unless a rule specifically says otherwise. |
| Roll damage | At the end of the target's turn, roll the persistent damage dice again and apply the damage. |
| Apply defenses | Immunity, resistance, and weakness apply to the persistent damage. Handle initial damage and persistent damage separately. |
| Attempt recovery | After taking the damage, the target attempts the recovery flat check, usually DC 15. |
| End or continue | On a success, that persistent damage ends. On a failure, it continues to the next turn. |
This timing matters. Persistent damage happens before many other end-of-turn condition reductions, and it cannot be dodged by using Delay to skip the bad part. Nice try, rules lawyer. The rules already saw you coming.
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Stacking Rules
Persistent damage stacks by damage type, not by source.
| Situation | Result |
|---|---|
| Persistent fire plus persistent bleed ● | Both apply. Roll each at the end of the turn, then attempt recovery checks for each condition. |
| Persistent fire plus stronger persistent fire ● | Keep the stronger fire damage. The higher same-type condition overrides the lower one. |
| Persistent fire plus unclear fire amount ● | The GM decides which source is higher or more appropriate when comparing fixed damage and dice is ambiguous. |
| Several types while dying ● | Very dangerous. The damage happens together, so damage-triggered dying increases should be handled once, but the character is still in serious trouble. |
Do not turn persistent damage into a spreadsheet fight. Track each active damage type, its amount, and whether it has ended. That is enough for most tables.
Damage Types
| Damage Type | Table Impact |
|---|---|
| Bleed ● | One of the most tactically important types because Medicine, biology, creature traits, and full healing all matter. It does not affect every creature. |
| Fire ● | Common, easy to picture, and often actionable. Water, smothering, dropping burning gear, or rolling can all be fair recovery attempts. |
| Acid ● | Excellent pressure because scraping, washing, removing gear, or neutralizing the source creates clear choices. |
| Poison ● | Dangerous when paired with afflictions, Fortitude pressure, and disease or poison defenses. |
| Vitality or void ● | Strong when creature type matters. Undead, constructs, healing interactions, and immunities can change the whole encounter. |
| Mental or spirit ● | Great for occult and divine scenes, but the GM should explain what can actually help. You cannot dunk your feelings in a bucket unless the scene says you can. |
For creature logic, use creature traits, Monster Core, and custom monsters. Bleed on a bloodless creature, poison on the wrong target, or vitality against a living creature should be checked before damage is rolled.
Assisted Recovery
Assisted recovery is the rule that lets a creature or ally take action to improve the recovery situation. The common pattern is a 2-action activity that plausibly addresses the damage and grants an immediate extra flat check before the normal end-of-turn check.
| Recovery Attempt | Ruling |
|---|---|
| Smothering fire ● | Strong and easy to adjudicate. Cloaks, dirt, rolling, water, or dropping burning gear can justify help. |
| Washing off acid ● | Excellent if water, solvent, magic, or gear removal is available. No water in the desert? That is the encounter talking. |
| Binding a wound ● | Use Administer First Aid for bleed. A healer's toolkit matters. |
| Using a relevant item ● | Alchemical, magical, and healing items can be great answers if they fit the damage type. |
| Generic "I help" ● | Ask what the character actually does. If the answer is still fog, do not hand out the best benefit. |
| Impossible help ● | You cannot bandage persistent fire, compliment acid into stopping, or Medicine-check a curse unless the scene supports it. |
The best GM habit is simple: reward specific action, tools, positioning, and risk. Do not make recovery free, but do not make players beg for obvious solutions either.
Medicine And Bleed
Medicine is the cleanest persistent damage interaction because Administer First Aid can be used to stop bleeding. If the target is both dying and bleeding, the healer chooses which problem they are treating first. That choice matters in tense combat.
| Situation | Best Call |
|---|---|
| Dying and bleeding ● | Decide whether stabilizing or stopping bleed is more urgent. Sometimes the correct answer is "both, but not with one action." |
| Bleed plus low Hit Points ● | Healing to full Hit Points automatically ends bleed, so big healing can be better than repeated flat checks. |
| No healer's toolkit ● | Medicine access gets worse. This is why adventuring gear is not just backpack decoration. |
| Nonliving target ● | Bleed generally does not apply if the creature is nonliving or does not need blood. Use another damage type or hazard. |
For related survival rules, see dying and death, conditions in combat, healer's tools, and consumables.
Player Options That Care
Persistent damage shows up across classes, spells, bombs, weapon runes, hazards, and monsters. Player Core and Player Core 2 both make the rule matter, especially for characters who create ongoing damage or have ways to patch it.
| Character Option | Why It Matters |
|---|---|
| Alchemist ● | Bombs and alchemical items are one of the most common ways persistent acid, fire, poison, bleed, splash pressure, and recovery tools enter play. |
| Rogue ● | Precision builds, wounding tools, and bleed-supporting options reward knowing when ongoing damage beats one more Strike. |
| Swashbuckler ● | Finishers can create ugly bleed pressure, especially when the target already has too many problems. |
| Monk ● | Some stances and strikes add bleed or void pressure, turning mobility into attrition. |
| Barbarian ● | High-impact critical options can add bleed. The class also tends to stay near the danger where persistent damage is common. |
| Champion ● | Defensive auras, disease and poison support, and reaction-based punishment all care about ongoing harm. |
| Oracle ● | Divine and cursebound options can create or resist persistent damage, but the class already tracks enough plates. Label your plates. |
| Druid and Wizard ● | Spellshape and energy effects can interact with persistent damage and resistance. This is where reading the whole spell matters. |
Spellcasters should cross-check combat spells, primal spells, arcane spells, divine spells, and occult spells.
Equipment And Hazard Sources
| Source | Why It Matters |
|---|---|
| Alchemical items ● | Bombs are a major source of persistent damage and splash pressure. They also make recovery decisions happen more often. |
| Runes ● | Flaming, wounding, vitality, void, and other rune effects can add persistent damage or ongoing pressure. |
| Weapons ● | Critical specialization effects and weapon traits can matter when persistent bleed or movement control appears. |
| Firearms ● | Guns & Gears-style tables often add more critical effects, reload choices, ammunition decisions, and bleed pressure. |
| Hazards ● | Traps, haunts, alchemical hazards, environmental threats, and monster lairs are great places for persistent damage. |
| Environment ● | Fire, acid, poison, cold, disease, terrain, and available water all affect whether recovery actions make sense. |
If a hazard gives persistent damage, give the party a way to understand the source. "The floor stabs you and now you bleed" is fine. "You take recurring damage for unknown reasons forever" is not tension; it is accounting.
GM Adjudication
Persistent damage needs consistent rulings because small differences are huge at the table.
| GM Question | Strong Answer |
|---|---|
| Can the target attempt assisted recovery? | Yes, if the action reasonably addresses the source and costs meaningful actions, tools, positioning, or risk. |
| Does a resistance apply? | Yes, apply immunity, resistance, and weakness to persistent damage separately from initial damage. |
| Does the initial save change persistent damage? | Usually, if the initial damage is negated, the attached persistent damage is negated too, unless the effect says otherwise or the fiction clearly separates them. |
| Can the same damage type stack? | No. Keep the stronger same-type persistent damage condition. |
| Does the damage trigger multiple dying increases? | If several persistent damage types hit at the same end-of-turn moment, treat the damage event carefully and do not multiply damage-triggered dying increases beyond the rule. |
| Should every fire effect have the same recovery action? | No. A burning cloak, magical flame, oil fire, and elemental curse can justify different answers. Tell players what their characters can perceive. |
Use GM screen reference, encounter building, adjusting encounters, and skill DCs when the rule starts affecting difficulty.
Tactical Advice
For Players
- Do not ignore low persistent damage at low Hit Points. A few points can be enough to drop you after your turn.
- Ask for a specific recovery action. "I dive into the fountain" is stronger than "Can I roll something?"
- Know when to heal to full. Full healing ends bleed, which can be better than gambling on flat checks.
- Track damage types separately. Fire and bleed are separate problems. Two fires are not.
- Carry tools. Healer's tools, water, consumables, and situational gear make the difference between clever and crispy.
For GMs
- Say the source clearly. Players need to know whether they are burning, bleeding, corroding, cursed, poisoned, or spiritually unraveling.
- Make recovery cost something. Actions, positioning, opportunity, and resources are fair costs.
- Do not overuse it. Persistent damage is spicy. Too much of it makes every fight feel like invoice processing.
- Watch dying characters. Persistent damage plus dying can end a character fast. Use the rules honestly and telegraph danger.
- Let monsters use it intelligently. Creatures with fire, acid, poison, bleed, or curse themes should pressure recovery choices.
Common Mistakes
| Mistake | Fix |
|---|---|
| Taking the damage immediately | Persistent damage normally waits until the end of the affected creature's turn. |
| Forgetting the recovery check | Roll the flat check after the damage. The damage does not just run until someone remembers. |
| Stacking same-type sources | Use only the stronger same-type persistent damage condition. |
| Letting everyone help for free | Assisted recovery should cost actions and make fictional sense. |
| Applying bleed to everything | Bleed depends on blood or a blood-like living system. Creature traits matter. |
| Ignoring full healing | Full Hit Points automatically ends bleed. That can change triage decisions. |
Hot Takes
- Persistent damage is an action-economy debuff wearing a damage hat.
- Low persistent damage is underrated. A DC 15 flat check fails often enough to make small numbers rude.
- Bleed is the most interesting type because it asks rules, biology, Medicine, and healing to all sit at the same table.
- The best recovery rulings are obvious after the player describes the action.
- If every monster in the dungeon deals persistent damage, the dungeon needs a hobby.
