WALK IT OFF: Rej’s guide to healing in D&D 5e

WALK IT OFF

A Guide To Healing and Support in D&D 5e
by Rejuvyn

Table of Contents

1. Introduction

2. What is Combat Really About?

3. So What is Healing Really About?

3a.  Healing Efficiency

3b.  Analyzing Turn Order

3c.  Healing to Prevent a Player from Going Down

4. Playing a Support Role

4a.  Damage Mitigation and Prevention

4b.  Hit Dice and Out of Combat Recovery

5. Healing/Buffing Spells and Abilities

5a.  Healing Spells/Abilities

5b.  Buffing Spells/Abilities

6. Changelog

1. Introduction

I'm hoping this guide can help some players who might be struggling with healing and support in D&D.  Please note that it's NOT meant to be the end-all, be-all guide that every prospective cleric/bard/druid has to follow.  There's simply too much variety to how the game is played to create a comprehensive guide that covers every nuance and corner case that a player might come across.  Rather, this guide is looking to offer some perspective regarding the support role, and perhaps a way to approach healing in combat that might help those who are feeling a little lost.  As this is almost always going to be a work in progress, I might change, add, or remove content as other players supply their own ideas and opinions.

2. What is Combat Really About?

Distilling combat into a simpler model is important to understanding what constitutes optimal decisions.  D&D combat is ultimately about RESOURCE MANAGEMENT, so if we look at each decision's impact on the various resources under consideration, then we can make better decisions about what might lead to the best long-term outcome.

Some of the resources to consider:

  • Hit Dice

  • Spell Slots

  • Limited Abilities: Rage, Bladesong, Wild Shape, etc

However, the primary "resource" to consider is ACTIONS.  Control abilities/spells are so powerful because they deny players or monsters actions.  Having Bonus Action or Reaction abilities lets you do more every round.  Killing a monster is impactful because they can no longer take actions.  Similarly, having a player eating dirt and doing nothing but rolling death saves means their actions cannot contribute to the battle.  Above all else, consider the impact of your decisions on everyone's actions.  We'll look at specific examples of this later on.

3. So What is Healing Really About?

If we look at combat as a game of resource management (and primarily about actions), healing is really about enabling actions.  A player or monster at 25% health is largely unchanged from being at 90% health.  Even being at 1hp doesn't prevent you from doing everything you'd normally be able to do at full health. 

Therefore, healing's primary purpose is to either:

  1. Prevent a player from dropping unconscious, and avoid loss of their actions.

or

  1. Bring back a player who has dropped unconscious, thereby keeping their actions in the fight.

To understand which of these options to take, we have to first talk about healing efficiency.

3a.  Healing Efficiency

Option (A) is often a mistake, and one that many players make if they don’t take resource management into consideration.  A modern approach to many games is to have the “holy trinity” of tanking, healing, and damage dealers, where the healers pump health into damaged players to keep them going.  This doesn’t work for D&D, for the simple reason that healing efficiency can very rarely match damage output from the enemy combatants (there are some exceptions, which I’ll go over later).  You’ll burn through your resources trying to keep everyone’s health up, wasting actions and spell slots for short-lived gains.

Here’s some math to illustrate healing efficiency:

  1. A medium encounter of six goblins against five level 2 players (assumes player AC 14) does 15 average damage in a round.  A 1st level spell slot cast of cure wounds (+3 spell mod) will heal around 7.5 hit points on average.

  1. A medium encounter of six troglodytes against five level 4 players (assumes player AC 16) does 31 average damage in a round.  A 2nd level spell slot cast of cure wounds (+4 spell mod) will heal around 13 hit points on average.  

  1. A medium encounter of eight bugbears against five level 6 players (assumes player AC 18) does 40 average damage in a round.  A 3rd level spell slot cast of cure wounds (+4 spell mod) will heal around 17.5 hit points on average.

And these are just Medium difficulty encounters (many fights feature Deadly difficulty), while using the highest level spell slot available with Cure Wounds, and it already falls behind.  This all gets worse at higher levels, as enemies bring CC, AOE, and more debuffs against players, in addition to raw damage.

So let’s look at Option (B).  The key difference is that healing a downed player adds the amount healed to 0 health, and this improves the “efficiency” of our healing.  Although getting hit hard enough to instantly cause death is a possibility (I’ll discuss this later), it’s rare enough that we’ll ignore that for now.

Some examples:

  1. A 2nd level player at 5 health takes 10 damage, dropping them unconscious.   Now when the player is healed by a level 1 Cure Wounds, it means 5 points of damage have already been “mitigated”, since any healing received starts adding hit points to 0 health, not -5 health.  That Cure Wounds cast has effectively countered an average amount of 12.5 points of damage.

  1. A 6th level player with 10 hit points takes 30 damage, only to be brought back up by a first-level Healing Word.  For a spell that normally averages 6.5 healing per cast, it instead just countered an average of 26.5 points of damage.

Over several battles, healing spent bringing up downed party members will have countered much more damage than healing expended trying to prevent them from dropping unconscious.  This goes a long way towards conservation of spell slots and maximizing the overall longevity of the party.  Therefore, healing efficiency should always be in the back of your mind when deciding when to heal someone.

However, combat is complex and varied, and there are many situations and variables that require additional consideration!  Remember that our goal is about enabling actions, so the most prominent factor to pay attention to is turn order.

3b.  Analyzing Turn Order

To illustrate why turn order is so important for a healer, here are two scenarios.

  1. The turn order is: Healer, Monster, Rogue.  (Rogue is down.)

    1. The Healer casts Healing Word and the Rogue is conscious, but prone.  

    2. Monster sees the prone Rogue is alive, and thus a threat, and attacks him with advantage.  Rogue goes down again.

    3. Rogue makes unhappy noises and rolls a death saving throw.

  1. The turn order is: Healer, Rogue, Monster.  (Rogue is down.)

    1. The Healer casts Healing Word and the Rogue is conscious, but prone.

    2. Rogue stands up, stabs the Monster, and bonus action disengages to move away.

    3. Monster makes unhappy noises and is forced to attack the high AC fighter.

Healing a downed player when the turn order has nearby enemies acting before the downed player runs the risk of having that player knocked out again before they can act.  This is sometimes necessary, particularly if the downed player already has two death saves and you need to “reset” their death save count.  Or it might be imperative to keep the monster in place, and a high AC defender can have a reasonable chance of surviving a hit or two even while prone.  However, it’s usually best to try and ensure that your healing will enable the downed player to take actions on their turn.  At higher levels, many monsters feature multi-attacks, so they could easily whack the prone player back to zero and move on to attack someone else.  If it seems like the downed player is unlikely to be attacked even if enemies go before them, then it’s probably safe to heal them on your turn.

If the turn order is not conducive towards our goal of enabling actions, then a possible workaround is to ready an action to heal.  Note that this won’t work with bonus action spells like Healing Word and readying a spell will break ongoing concentration.  If the spell doesn’t go off for some reason, then you lose the spell slot.  It’s common for the application of a healing potion to someone else to require an action (it depends on your DM’s table rules), making healing potions a good way to get around turn order problems while retaining concentration.  The downside is that it requires you to be next to the downed player, which can be risky if the monster that downed the player is now without a target and looking at you.

If you’re close enough to the downed player and you cannot work around a problematic turn order, then you (or another player) could also drag the downed player away from immediate danger.  This will only work if another standing player is also adjacent to the monster and can dissuade it from moving away, and it also consumes more actions.  An alternative is for another player to shove the monsters away, or to grapple and drag them.  As always, control spells are powerful and can buy you the time you need to safely bring someone up and back into action.

Although the game intent is for most enemies to ignore unconscious players in lieu of active threats, this is not always the case.  Be aware of when your DM might steer a monster to try and “finish off” a downed player, and quickly bring them back to positive health before the monster can deal a death blow.

3c.  Healing to Prevent a Player from Going Down

I mentioned that Option (A) was often a mistake, but sometimes the situation merits early healing.  I’ve listed some examples of this, although this is not a comprehensive list:

  • Enemies can ambush in waves, or hide until a more opportune moment.  If the fight looks too easy, then it’s possible you haven’t encountered all enemies.  If someone is injured and you suspect more enemies might be added to the turn order, then some preemptive healing might be warranted since the turn order could become problematic.

  • Healing can sometimes keep up with enemy damage output.  This is more prevalent at really low levels when enemy damage keeps to the single digits.  At high levels, powerful healing spells can provide either a substantial burst of healing, multi-target healing, or healing that occurs over several rounds.  These are very action-efficient and can keep multiple players on their feet for a while longer.

  • If you’re up against a really heavy hitter, then instant death becomes a concern if the targeted player is really low on health.  Instant death can occur if the damage from a single attack puts the player’s health at the negative value of their maximum health.  Critical hit damage from such enemies could potentially exceed this threshold, so some early healing can act as insurance against unlucky dice rolls.

  • Sometimes, keeping a player up is important to avoid the loss of other resources.  Barbarian Rage and Bladesong are examples of important abilities that are lost if the character drops unconscious.  Concentration is also dropped if the character goes down, which might result in the loss of important buffs or the loss in control of a CC’ed enemy.  A grappler who is pinning down a dangerous monster would also lose their grip on them if they drop to zero health.

  • Some sub-classes can enhance healing output significantly (example: Life Clerics, Divine Soul Sorcs), while others feature resistance to damage types (example: Barbarians, Ancient Paladins).  Both of these drastically improve healing efficiency, making preemptive heals more attractive in certain party compositions.

  • Special abilities that enable actions/perks off of spell casts/healing can also be worth triggering.  The Order Cleric’s reaction attack from spellcasting, rider abilities that allow OA-free movement, or anything that adds extra temporary hit points, these are benefits that should be considered for early healing.

So whether we go with option (A) or (B) really depends on the specifics of the situation.  Ultimately, it boils down to maximizing the efficiency and efficacy of the party’s actions.  As long as you keep this in mind, you’ll improve the party’s longevity and survival.

4. Playing a Support Role

In general, support players should not be engaging in the front lines.  Certain builds can tank the front lines relatively safely while providing support and healing (heavy armor Clerics being a notable example), but most support characters should be looking for the safest position away from danger.  If you are the sole healer, then going unconscious will likely cripple the party.

For anyone looking to stay out of trouble, the top three things to remember are location, location, and location!  Various factors to consider:

  • Possible ambushes from nearby buildings, foliage, etc.  Don’t stray too close to anything that could be hiding enemies.   

  • Be aware of the move speed of enemies, make sure that they can’t slip past the front line to reach you easily.

  • Spacing from your party members to avoid cone/AOE attacks.

Always check to make sure someone else in the party has some means of healing.  Healing Potions, Lay on Hands, spare spell slots from half-casters (I’m looking at you, Rangers), these are all useful as backup measures in case you go unconscious, if you run out of resources, or to help you deal with turn order problems.

Aside from making judgement calls on when/how to heal, there is much that can be done as a support player to keep your party up and running.  While communicating and coordinating with allies is everyone’s responsibility, the support player often has the best perspective to help the party make good tactical decisions.  In particular, we want to pay attention to damage mitigation/prevention, and also maximizing our use of out of combat recovery.

4a.  Damage Mitigation and Prevention

Direct healing isn’t your only recourse to dealing with damage.  Conferring disadvantage upon enemy attacks goes a long way towards conservation of spell slots and resources, and should always be a powerful tool for everyone to consider.  The simple DODGE action is underused by most players, even those who are familiar with the game!  Learn to identify the situations where it’s a better use of a player’s action to Dodge instead of attacking (usually when they’re surrounded or isolated), and kindly suggest to them that mitigating all that potential damage might be a wise move.  Players often develop tunnel-vision and want to maximize their damage output, so a well-placed suggestion on when to Dodge from the party’s support player can prevent a lot of headaches.

Don’t take OAs (opportunity attacks) from enemies unless your action is urgently needed, or unless you have high AC.  The possible damage taken could offset anything your action does, and this is true for your damage dealing party members as well!  Using the DISENGAGE action might feel like a waste of an action, but remember that it’s avoiding damage and putting the player(s) in a much better position.  Squishier melee damage dealers usually have the means to attack and disengage in the same turn (Cunning Action, Step of the Wind), but often fail to do so.  Ranged damage dealers suffer from the same sort of tunnel-vision and tend to take OAs in an effort to avoid disadvantage with their attacks, but this is rarely a good tradeoff.  Encourage your allies to force heavy-hitting enemies to direct their attacks at your more resilient party members by using Disengage to remove themselves from enemy reach.

Much of damage mitigation and prevention can easily boil down to these two actions, but convincing your party members to use them is the tricky part.  Dealing damage feels good and is fun, so it’s natural for many players to forget about other options that might lead to better sustainability or efficiency.  As the support player who is keen on keeping everyone up and running, politely remind them of these options when the situation calls for it.  Clear and constructive communication with your group is often the key to success!

4b.  Hit Dice and Out of Combat Recovery

Hit Dice are a very important resource, and in general you should try and push as much healing onto hit dice as you can.  If you’re able to foresee a short rest opportunity coming up, then resist the urge to heal anyone who is heavily damaged in lieu of letting Hit Dice save your spell slots.

Support for out-of-combat recovery is important for the same purpose!  Various recovery spells are only usable (or best used) outside of combat, but they are very efficient for party recovery and can supplement Hit Dice.  Anything that enhances Hit Dice efficiency (Song of Rest is spectacular) is also very valuable.  Having these spells or abilities at your disposal is an important consideration when selecting what spells go into your arsenal for the day.  More powerful healing potions can also aid in recovery without expending spell slots or Hit Dice.

Planning for how many combat encounters the group can reasonably tackle before needing a rest often falls to the support player, because they have the best sense of how far they can stretch their resources and what the group’s out-of-combat recovery options are.  Knowing when the party has reached its limit and needs to retreat or rest can be a tough judgement call, but it’s up to the support player to initiate that discussion when it’s time.

5. Healing/Buffing Spells and Abilities

This section is meant to give an idea of what general strengths and purposes each healing or buffing spell/ability has.  I’m only going to cover up to 3rd level spells, and abilities that require up to player level 5.  Crowd Control (CC) spells, self-only buffs, and buffs that don’t enhance healing or defense are beyond the scope of this guide.  I don’t list all the properties and functions of each spell/ability, just their strengths and uses.

Spells are listed first, then Abilities.  Within each category, they are ordered alphabetically.

5a.  Healing Spells/Abilities

  • Aura of Vitality [3rd level spell] (Cleric, Druid, Paladin):  Ranged heal, requires Concentration.  Over enough rounds of combat, this can be an efficient way to heal using your Bonus Actions.  It competes with buffs as it requires Concentration.  This is an efficient out-of-combat heal, and you can keep healing with it after combat ends until the spell expires, making it best used closer to the end of combat.

  • Cure Wounds [1st level spell] (Artificer, Bard, Cleric, Druid, Paladin, Ranger):  Touch range, but you can ready-an-action delay this spell for turn order issues.  Many non-support classes have this as a backup.  Can be worth upcasting if a stronger healing boost is needed immediately, but this is rare.

  • Dispel Magic [3rd level spell] (Artificer, Bard, Cleric, Druid, Paladin, Sorcerer, Warlock, Wizard):  Important for removing debilitating debuffs that can both disable actions and increase vulnerability to attacks.  Becomes more important at higher levels.  Worth upcasting to guarantee removal of really dangerous effects.

  • Goodberry [1st level spell] (Druid, Ranger): Combines with Life Cleric perks for strong out-of-combat healing.  Depends on your DM’s ruling, but can often be used as a “mini health potion” for bringing back downed players in combat.  Like potions, applying a berry can be a readied action without breaking concentration.

  • Healing Spirit [2nd level spell] (Druid, Ranger):  Bonus Action cast, but it requires Concentration.  Great healing efficiency for a tank who has to anchor in one spot while in combat.  It competes with buffs and CC spells, as it requires Concentration.  When out-of-combat, you can easily distribute the healing as needed among different allies.  Worth upcasting as it heals multiple times.

  • Healing Word [1st level spell] (Bard, Cleric, Druid):  Bonus Action cast, ranged healing spell.  Best used to bring back an unconscious player in combat from a safe distance.  Not worth upcasting.

  • Lesser Restoration [2nd level spell] (Artificer, Bard, Cleric, Druid, Paladin, Ranger):  Important for removing certain debilitating debuffs, as some of them not only disable actions, but make the victim more vulnerable as well.  Tends to become more important at higher levels.

  • Life Transference [3rd level spell] (Cleric, Wizard):  Ranged healing spell.  This is an efficient heal, and also a good way to spread damage for better Hit Dice usage.  Not worth upcasting.

  • Mass Healing Word [3rd level spell] (Bard, Cleric):  Bonus action cast, ranged healing spell.  Useful for healing multiple unconscious allies, but isn’t efficient enough for other situations.  Not worth upcasting.

  • Prayer of Healing [2nd level spell] (Cleric, Paladin):  Only for out-of-combat healing due to the long cast time, but it’s very efficient if the damage has been spread out.  Worth upcasting as it affects up to 6 allies.

  • Channel Divinity: Balm of Peace [level 2 ability] (Peace Cleric):  Although dependent on the positions of party members, this can be very efficient healing if damage has been spread out.  Can be utilized out-of-combat to apply it to all party members.

  • Channel Divinity: Preserve Life [level 2 ability] (Life Cleric):  Ranged heal.  Very strong and efficient, it can heal a single downed player a significant amount, or spread the heal among multiple injured allies.

  • Channel Divinity: Turn the Tide [level 3 ability] (Crown Paladin):  Bonus Action.  Similar to Mass Healing Word, but only heals those below half health and they must be able to “hear” you.  It’s up to the DM’s interpretation if that means an unconscious ally could be healed by this, but most interpretations seem to think that it cannot.

  • Hands of Healing [level 3 ability] (Way of Mercy Monk):  Being able to apply this during Flurry allows for great action economy.  At higher levels, this becomes decent healing at the cost of 1 Ki.

  • Healing Light [level 1 ability] (Celestial Warlock):  Bonus action, ranged heal, does not use spell slots.  Similar to Healing Word, it should only be used one at a time to bring up an unconscious ally.

  • Lay on Hands [level 1 ability] (Paladin): Does not use spell slots, but has Touch range.  It’s best used to grant 1 hp to bring up an unconscious ally.  Can delay with ready-an-action to deal with turn order problems while retaining Concentration.  It can be used in an emergency to pump a large amount of healing in at once to absorb multiple attacks, but it’s best to save a few points of healing for emergencies.  It’s rarely a good use to dispel poisons or diseases.

  • Spirit Totem [level 2 ability] (Circle of the Shepherd Druid): Grants a decent amount of temporary hit points with Bear spirit, but Unicorn spirit is a massive boost to group healing at higher levels, which will quickly add up over several rounds.

5b.  Buffing Spells/Abilities

  • Aid [2nd level spell] (Artificer, Bard, Cleric, Paladin, Ranger):  Doesn’t use Concentration, lasts 8 hours.  Essentially a small, but significant “pre-heal”.  At higher level casts, can outperform other group healing spells, and it can bring up unconscious players like regular heals.  Definitely worth upcasting.

  • Barkskin [2nd level spell] (Druid, Ranger):  Lasts an hour.  Useful for Wild Shape forms, but that’s about it.

  • Beacon of Hope [3rd level spell] (Cleric):  Very powerful against spell-casting enemies who target Wisdom, and it dramatically boosts the healing efficiency of many healing spells and abilities.

  • Bless [1st level spell] (Cleric, Paladin):  Affects 3 players!  Improving Saving Throws is extremely important for damage mitigation and CC avoidance.  This is one of the most powerful buffs in the game.

  • Heroism [1st level spell] (Bard, Paladin): Mainly used to counter the Frightened debuff.  The round-to-round self-refreshing damage absorption can mitigate a good amount over time.  Worth upcasting to apply to more allies against consistent spread-out damage, or against lots of fear effects.

  • Intellect Fortress [3rd level spell] (Artificer, Bard, Sorcerer, Warlock, Wizard):  Lasts an hour.  Very important against creatures that deal a lot of psychic damage, and against most debilitating magic.  Worth upcasting to expand protection to more allies.  Only important at higher levels.

  • Invisibility [2nd level spell] (Artificer, Bard, Sorcerer, Warlock, Wizard): Can be used as an emergency defense against attacks and spells, useful for someone maintaining Concentration on a crucial spell, or to escape.

  • Protection from Energy [3rd level spell] (Cleric, Druid, Paladin, Warlock, Wizard):  Lasts an hour.  Elemental damage can be very dangerous at high levels, this is important for mitigating damage against enemies that use a specific type.

  • Protection from Evil and Good [1st level spell] (Artificer, Cleric, Druid, Sorcerer, Wizard):  Lasts 10 minutes.  Some of the types of creatures that this protects against can be very dangerous, and this helps counter them.  More useful at higher levels.

  • Protection from Poison [2nd level spell] (Artificer, Cleric, Druid, Paladin, Ranger):  Lasts an hour, and doesn’t require Concentration.  Only useful against specific enemies that deal a lot of poison damage, or have debilitating effects from applying poison.

  • Sanctuary [1st level spell] (Artificer, Cleric):  Bonus Action cast, and doesn’t use Concentration.  Useful as an emergency deterrent to keep someone alive to aid their escape/recovery/concentration, is somewhat similar to conferring disadvantage on attacks against them.

  • Shield of Faith [1st level spell] (Cleric, Paladin):  Bonus Action cast, best used to stack on someone who already has high AC to counter hard-hitting attacks.

  • Warding Bond [2nd level spell] (Cleric, Paladin):  Lasts an hour, doesn’t require Concentration.  Useful for some added protection, and for spreading out damage for better Hit Dice usage.

  • Channel Divinity: Twilight Sanctuary [level 2 ability] (Twilight Cleric):  Doesn’t require Concentration.  Good for self-refreshing damage absorption, and removing fear or charm.  Over enough rounds, it can absorb a large amount of damage for multiple allies.

  • Channel Divinity: Watcher’s Will [level 3 ability] (Watchers Paladin):  Doesn’t require Concentration.  Offers great protection against many types of control magic.

  • Emboldening Bond [level 2 ability] (Peace Cleric):  Lasts 10 minutes, doesn’t require Concentration.  This is a lightweight version of Bless, and it stacks with Bless!  This is an extremely powerful buff since it doesn’t require concentration, but still boosts saving throws.

6. Changelog

12-08-2020:Initial draft.

12-10-2020:Added Table of Contents.

Updated entry on the Aid spell.

Made the colors less jarring.

12-11-2020:Added Spirit Totem ability.

Added part about enemies who might attack downed players to the Turn Order section.

Added Hands of Healing ability.

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