These optional rules are meant to conform to the standard rules for injuries as detailed on pp.51-53 of Call of Cthulhu, 5.5 edition, and are not designed to reinvent the wheel. Not all DG WWII campaigns will take place on the battlefield, but some will and many will involve more firepower than the usual CoC campaign. There is a good chance that player characters could get killed through random violence rather than in a dramatic manner, and though this reinforces a gritty atmosphere it can ruin the logic of planned-out scenario. These rules are meant to preserve that gritty atmosphere through severe penalties for getting in the way of a bullet, yet allow the character a better chance to survive without forcing the Keeper to suspend disbelief by "fudging the rules" to keep player characters alive.

These rules can make combat a much-more complicated affair, so it is best reserved for PCs and named NPCs, and not for the average cultist or guard. If you prefer that death be more random, simply observe the standard rules that 1-2 HP is unconsciousness and 0 HP or less is death.

SHOCK
In game terms, shock is the final stage where the body begins to decompensate and will soon die. This is not meant to simulate any clinical definition of shock, as there are several different kinds of shock. A character is in danger of going into shock for any of the following reasons:

• The character's HP reaches 1 or 2.
• The character loses more than half their total HP from a single injury.
• The character's HP becomes zero or less.

When a character is in danger of going into shock, follow this procedure:

1. The character must roll CONx5.
2. If the roll fails, the character has gone into shock (see below).
3. If the roll succeeds, the injury must be stabilized. Until the wound is stabilized, roll against CON each round, CONx4 in the next round, then CONx3, CONx2, and finally CONx1. Any failure on the CON roll means that the character has gone into shock (see below).
4. As long as the character is conscious, they can perform actions. Physical actions beyond speaking or writing require the character to roll CONx5. If the character fails the roll, not only can the action not be performed, but the exertion causes the character to go into shock (see below).
5. Once the character is stabilized, they can recieve medical treatment. If character's HP is raised to 3 or more, they are out of danger of shock and are free to act without reprecussions. If character's HP is 2 or less, they must roll CONx5 to perform any significant physical action, with failure causing the character to go into shock (see below).

If a character goes into shock, they immediately fall unconscious and loses 1 HP per round until they are stabilized. If at any time, a character in shock has an HP of zero or less, they die in 1D4 rounds unless they are immediately stabilized.

STABILIZATION
This is the use of basic life support techniques to stabilize the seriously wounded patient until advanced medical attention can be performed. In game terms, stabilization is accomplished by a either successful First Aid or Medicine roll. This roll can be attempted once per round until the victim is either stabilized or dies. Only one person can attempt the roll on any one patient at a time. Stabilization does not require any special tools and can be performed anywhere. A character can attempt to stabilize their own injury at half-skill, but the exertion could cause the character to go into shock. The roll for stabilization uses the same procedure as a First Aid or Medicine roll to restore 1D3 HP, but these are two seperate rolls.

DEATH
Under these optional rules, when a character's HP reaches zero or less, they are not dead but are dying. If the character can recieve proper medical attention in sufficient time, they can survive. When a character suffers an injury that reduces their HP to zero or less, follow this procedure:

1. Record the number of hit points lost (ie. a character with 11 HP is damaged by 17 points for -6 HP). If a character's HP drops to less than -30, they are hopelessly and immediately dead.
2. The character is in danger of going into shock. Follow the procedure for shock until the character is either stabilized or dead.
3. Once the character is stabilized, they cannot recieve treatment to regain HP until they recieve surgical treatment. The character will remain in a state of zero or negative HP until then.
4. Any character with zero or negative HP must recieve surgical treatment in 4D10+15 minutes or die from their wounds. This is a game approximation of the Golden Hour of emergency medicine.

SURGICAL TREATMENT
Surgical treatment is required to bring a character near death out of critical condition. To perform surgical treatment, a character must make a successful Surgery roll, with the following result:

• Success raises the character's HP by 1D10 to no more than 1 HP. Surgical treatment cannot restore lost HP, but simply raises a character's HP above zero.
• Failure means that the character loses 1D4 HP and the character will die in the following round unless they are stabilized by a successful First Aid or Medicine roll. If the character's HP drops below -30, then they are immediately dead on the operating table.

The Surgery skill is modified by a number of factors and can be attempted more than once. See the expanded skill description for further details.