Death Saves and Cardiac Arrest Protocols

09 Sep, 2026

I'm gearing up to run a dnd game for a bunch of paramedics and I thought it'd be fun to incorporate cardiac arrest protocols into death saves.

Death Save is now a ROSC¹ roll

When a character reaches 0HP, roll for ROSC: 1d20 >= TN.

The roll may be repeated every 2 minutes (2 combat rounds).

Magical healing may increase HP no further than zero until ROSC is achieved. It therefore has some utility in reducing the TN, but cannot be solely relied on for resuscitation.

Modifiers

Add relevant modifiers to each roll.

positive modifiers

• +1 for effective chest compressions with minimal interruption. CON check every 4 minutes to continue delivering effective CPR
• +1 for adequate delivery of ventilations (mouth to mouth, BVM²)
• +2 for any reversible causes addressed. These will mostly require successful INT or DEX checks.
  • Hypoxia: Definitive airway and ventilated with 100% oxygen(intubated, o2 tank, Gust spell, etc.)
  • Hypovolaemia: IV fluids and inotropes, tourniquets applied, pelvic and long bone fractures splinted
  • Hyperkalemia/metabolic: IV insulin + dextrose, calcium gluconate
  • Hypoglycaemia: parenteral glucose
  • Toxins: Contaminants removed, antidotes given
  • Tension pneumothorax: Thoracocentesis or finger thoracotomy
  • Tamponade: Pericardiocentesis -- High difficulty DEX check

negative modifiers

• -1 for every successive minute after initial cardiac arrest
• -1 for every minute without continuous effective chest compressions
• -1 for comorbidities; every serious illness, injury, or curse the character had prior to cardiac arrest counts as a comorbidity.

special circumstances

Shockable rhythms: Characters who were struck by lightning, ingested arrhythmic poisons, or who have suffered a heart attack may present in a shockable rhythm. For these patients, if they are given a therapeutic electric shock(defibrillator, lightning spell, precordial thump) within 2 minutes, roll with a TN of 11 and +4 to the roll.

Hypothermia: Hypothermic characters do not begin accumulating negative modifiers for time elapsed since cardiac arrest until they are fully warmed.

**Signs Incompatible with Life: ** ROSC is impossible when any of the following are present:

• Rigor or livor mortis; putrfaction; bloating(usually a sign the character has been dead for an extended period)
• Cranial destruction or decapitation
• Traumatic hemicorporectomy³

Running Cardiac Arrests

The ideal scenario for these rules to be used is mid-combat. A character who is performing CPR, ventilating the patient, or performing a procedure will be wholly task focused and unable to fight. The challenge becomes managing human resources while fighting the enemy and (optionally) trying to extricate the patient.

Allow for significant amounts of mcguyvering that wouldn't fly in real life: needle crics and chest tubes with a BIC pen, intubating with rubber hoses, and defibrillating with car batteries.

In fantasy settings, let them use Gust and Lightning spells, magic hands, and unseen helpers to perform CPR, defibrillate, and ventilate, etc.