Avoiding Death

There are no negative hit points. When you reach zero, a die is rolled, modified by the damage that would have been taken below zero, and the result is compared to a table of effects, depending on the damage type. Sometimes the effect is a status effect (stunned, deafened, blinded, etc), sometimes an injury of differing severity, from cracked ribs to amputations, sometimes death.

It should be noted that there is an upper limit on the possible result based on the amount of damage dealt; the die roll is 1d6 and the table goes to 36, so in order to max out the table (invariably death), you'd have to take at least 30 points of damage past zero.

Unless an injury says otherwise, you continue to act normally. You are not staggered at zero hit points and do not fall unconscious.

On the players' end, things are pretty simple. When your character is reduced to zero, I will roll, add the modifiers from the damage dealt and previous injuries (some injuries affect the die roll), and give you the result.

Example:

Guy Ecsampel is fighting an orc and gets hit with an axe for 9 points of damage. With Guy's 7 hit points, he would be dropped to -2. The GM rolls 1d6+2 and comes up with a total of 5. The 5 result on the Edged/Slashing weapons table is "The weapon strikes you cutting through your armor and clothing. You are now indecent. Anyone who attacks you is at a minus equal to your Charisma modifier." Guy is a little embarrassed, but otherwise unharmed, though now at zero hit points.

A couple rounds later, Guy gets clubbed by an ogre for 12 points of damage. Since he's already at 0 hp, all 12 gets added to the die roll, for a total of 18, since the GM rolled max. The result is "Crushing strike to abdomen fractures ribs and damages organs. You taste bitter copper as you vomit blood. Fall prone until you make a successful Fortitude save (DC 15). If you are not wearing armor on your torso, you are dead in 2d6 rounds. Fractured Bones. First Aid: Sickened. Internal Bleed 3. Pain 2." This time, Guy's not doing so hot, though at least his armor kept him from dying outright. He's Sickened until he can get some healing, and that Pain is felt as a penalty on all die rolls Guy makes. He's also bleeding internally, and until he gets proper healing, there's a 3% chance each round that he'll keel over dead.

All of that sounds awful, of course, but if Guy had a Constitution score of 12 or less, he'd be dead, so maybe those fractured ribs aren't so bad after all.