Injury

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Humanoids, animals, and mechanoids sustain injuries from sources including melee weapons, weapons fire, explosions, ceiling collapses, and fire. Each source of damage comes with a specific Damage Type. Colonists, visitors, and prisoners can be operated upon and may suffer an injury from a surgical mistake. Each kind of injury has a value of pain, a description for its scar, and flavor text for being mended by medicine. A colonist in shock from extreme pain or incapacitated due to loss of movement becomes 'downed'. Doctors will automatically rescue downed colonists.

Health Difficulties

Main article: Health Difficulties

These are the general types of injuries that can be inflicted on a colonist. A bladed weapon would cut you, while a firearm would inflict gunshots, etc.

Name	Pain	Scar pain	Old Label	Combines?	Bleeding	Infection Chance	Become Old Chance	Naturally Heals	Destroyed	Destroyed Out	Treated	Inner Treated	Solid Treated
Beam Burn	1.25	0.625	Old beam wound	No	6%	30%	?%	Yes	Burned off	Burned out	Bandaged	Sutured	Set
Burn	1.875	0.625	Burn scar	Yes	0%	30%	1%	Yes	Burned off	Burned out	Bandaged	Sutured	Set
Chemical Burn	1.875	0.625	Burn scar	Yes	0%	30%	1%	Yes	Burned off (chemical)	Burned out (chemical)	Bandaged	Tended	Tended
Crush	1.25	0.625	Scar	Yes	1%	15%	1%	Yes	Crushed	Crushed	Bandaged	Sutured	Set
Crack	1.0	0.625	Scar	?	0%	0%	0%	Yes	Shattered	Shattered	Set	Set	Set
Cut	1.25	0.625	Cut scar	Yes	6%	15%	1%	Yes	Cut off	Cut out	Bandaged	Sutured	Set
Surgical Cut	1.25	0.625	Cut scar	Yes	6%	15%	1%	Yes	Cut off	Cut out	Bandaged	Sutured	Set
Scratch	1.25	0.625	Scratch scar	No	6%	15%	1%	Yes	Torn off	Torn out	Bandaged	Sutured	Set
Bite	1.25	0.625	Bite scar	No	6%	30%	1%	Yes	Bitten off	Bitten out	Bandaged	Sutured	Set
Stab	1.25	0.625	Stab scar	No	6%	15%	1%	Yes	Cut off	Cut out	Bandaged	Sutured	Set
Gunshot	1.25	0.625	Old gunshot	No	6%	15%	1%	Yes	Shot off	Shot out	Bandaged	Sutured	Set
Shredded	1.25	0.625	Scar	Yes	6%	20%	1%	Yes	Torn off	Torn out	Bandaged	Sutured	Set
Bruise	1.25	0.625	Old bruise	No	0%	0%	0%	Yes	Destroyed	Destroyed	Bandaged	Sutured	Set
Frostbite	1.25	0.625	Frostbite scar	Yes	0%	25%	1%	Yes	Lost to frostbite	N/A	Bandaged	Sutured	Set
Missing Body Part	-	-	-	-	12%	-	-	-	Gone	Gone	-	-	-
Misc	1.25	0.0	Scar	No	6%	?	1%	Yes	Destroyed	Destroyed	Bandaged	Sutured	Set

Feelin' the Pain

Main Article: Pain

Most biological creatures including colonists, raiders, and animals feel pain caused by injuries. A pawn's pain level ranges from 0% to 100% and is displayed on their Health tab's Overview. Pain levels are None, Little, Moderate, Severe, and Extreme.^{[Detail Needed]} Even a little pain causes unhappy thoughts. Once pain passes 10%, it'll start to have an effect on consciousness. If a pawn's pain level meets or exceeds their Pain Shock Threshold they'll go into shock, unable to move. Pawns with the Wimp trait will be incapacitated with only minor pain of 30%.

Most pain is temporary, but scars and certain diseases can cause long-term pain. A painstopper implant or the Painblock psycast will get rid of all a colonist's pain and negate any pain-related mood penalties. Note that colonists with the Masochist trait or an ideoligion with the Pain: Idealized precept get a mood bonus from pain instead of a penalty, so it's usually better to leave them alone.

Injuries to the artificial parts do not cause any pain, so colonists with a lot of bionics will generally incur less pain during combat.

Formula

Pain for a given pawn is the sum of the pain from each individual injury, with two extra steps at the end:

• pain = pain / healthFactor for pawns with a healthFactor other than 1.0 (like grizzly bears and other large animals). Humans have a healthFactor of 1.0, so this doesn't impact humans
• pain = pain * painFactor from health conditions which alter pain. This includes pain-reducing drugs like flake and yayo as well as anesthetic used during operations

Pain from an individual injury is the product of the severity of the injury (the number of HP missing for things like cuts and burns) and the pain per severity for the injury type. For example:

• 30 burn damage causes 30 damage × 0.01875 pain per severity = 56.25% pain
• 30 cut damage causes 30 damage × 0.0125 pain per severity = 37.5% pain

For the complete table of pain vs damage, see Health Difficulties

Thresholds

Pain creates moodlets of different values at 4 stages depending on pain severity.

Level	Required Pain %	Mood Penalty (Default)	Mood Buff (Masochist)	Mood Buff (Pain:Idealized)
Minor	1%	−5	+5	+3
Serious	15%	−10	+10	+5
Intense	40%	−15	+15	+7
Mind-shattering	80%	−20	+20	+9

A standard pawn will go down upon reaching mind-shattering pain.
Pain inflicts a consciousness penalty that scales with the pain percentage after exceeding 10%. It conforms to the following equation: IF Pain[%] <= 10% THEN -0% ELSE -{(Pain-0.1)/2.25}[%] For example, 15% pain is 0.15 - 0.1 = 0.05 / 2.25 = 0.02 or 2% consciousness loss.

Graph

Factors

Base factors

Factors cause the game code to MULTIPLY pain X a number. Small numbers reduce pain a lot. Large numbers reduce pain a little.

• Painstopper: ×0%
• Painless persona trait : ×0%
• Go-juice:
  • High: ×10%
  • Withdrawal: ×300%
• Painblock psycast: ×10%
• Yayo:
  • High: ×50%
• Luciferium:
  • High: ×80%
• Psychite tea:
  • High: ×90%
• Beer: (See also Offsets)
  • Warm: ×90%
  • Tipsy: ×80%
  • Drunk: ×50%
  • Hammerred: ×30%
  • Blackout: ×10%
• Psychic bond:
  • Psychic bond: ×50%
• Reduced pain: ×50%

Offsets

Offsets cause the game code to ADD OR SUBTRACT a number from the pawn's pain. Small numbers are less effective at reducing pain than large numbers. However, if the pawn only has a small amount of pain, an equally small offset will be totally effective at removing all pain. Positive numbers add pain. Negative numbers reduce pain.

• Mindscrew: +20%
• Sensory mechanites:
  • Mild pain: +20%
  • Intense pain: +60%
• Blood rot:
  • Extreme: +5%
• Fibrous mechanites:
  • Mild pain: +20%
  • Intense pain: +60%
• Muscle parasites: +20%
• Gut worms: +20%
• Malaria:
  • Major: +30%
  • Extreme: +30%
• Luciferium:
  • Withdrawal: +40%
• Beer: (See also Factors)
  • Blackout: +5%
• Stoned on smokeleaf: −20%
• Torture crown: +5%
• Tox gas:
  • Mild: +10%
  • Moderate: +15%
  • Severe: +25%
• Hemogen craving:
  • Minor: +5%
  • Moderate: +10%
  • Major: +15%
• Inhumanization: −50%

Recovering from injuries

Injured colonists will recover from their wounds over time. Every couple of minutes in game, a random injury will be healed by a small amount. This healing reduces the severity of the injury, and when the severity of the injury reaches zero the injury is fully healed.

Every 600 ticks heal rate × 0.01

points of damage are healed from a randomly selected (non-permanent) wound.

The exact heal rate is determined by adding up three factors:

• Default healing rate: All pawns have a base heal rate of 8
• Is the pawn lying down / in a bed?: +4 for resting on a sleeping spot or the ground, +8 for resting on a bed / bedroll, and +14 for resting on a hospital bed
• Is the wound tended?: +4 for a 0% quality tend and +0.08 per point of tend quality, up to +12 at 100% tend quality

To put this in perspective, consider a colonist who has taken 20hp of damage to various body parts. The colonist heals heal rate × 0.01

points of damage every 600 ticks, so they'll need 20 ÷ (heal rate × 0.01)
ticks to fully recover.

To give a few examples:

• Do nothing: With no tending or rest, they get the base heal rate of 8, so it'll take 150,000 ticks (2 and a half in-game days) to heal
• Basic tend and resting: With a 40% tend quality (+7.2) and rest in a non-hospital bed (+8), they have a heal rate of 8 + 7.2 + 8 = 23.2, so it'll take 51,724 ticks to heal (around 21 hours in game)
• Best quality care: With 100% tend quality (+12) and rest in a hospital bed (+14), they have a heal rate of 8 + 12 + 14 = 34, so it'll take 35,294 ticks to heal (around 14 hours in game)

Note that immunity gain speed has no influence on the recovery rate from injuries -- it only affects recovery from disease

Non-Local Injuries

Starvation

When a pawn's food meter reaches 0% they will begin to suffer from malnutrition, shown on the Health tab. When a colonist is starving they will prioritize eating over other activities, including firefighting and doctoring.

• Malnutrition starts at 0%; upon reaching 100%, the pawn will die.
• Malnutrition (trivial): consciousness -5%, 150% hunger rate
• Malnutrition (minor): consciousness -10%, 160% hunger rate
• Malnutrition (moderate): consciousness -20%, 160% hunger rate
• Malnutrition (severe): consciousness -30%, 160% hunger rate
• Malnutrition (extreme): consciousness max 10%
• Malnutrition (100% severity): death

Blood Loss

Blood loss occurs when a pawn has untreated bleeding wounds. Bleeding wounds are identified on the Health tab by a blood icon and a tooltip shows the bleeding rate. Total blood loss is listed under Whole Body and its tooltip shows the total blood loss. Overall bleeding rate is shown at the bottom.

Once all bleeding wounds are healed the pawn will start recovering from blood loss. It takes up to 4 days to fully recover.

• Blood loss starts at 0%; upon reaching 100%, the pawn will die.
• Blood loss (minor): consciousness -10%
• Blood loss (moderate): consciousness -20%
• Blood loss (severe): consciousness -40%
• Blood loss (extreme): consciousness max 10%
• Blood loss (100% severity): death

Shock

Caused by extreme pain, it incapacitates the affected target. There are no other causes of shock besides pain currently.

Pawns go into shock if their amount of pain is greater than 80%, except for wimps which are downed at 20%.

Heatstroke

Heat stroke occurs when a pawn has prolonged exposure to temperatures well above their maximum comfortable temperature.

• Heatstroke (initial): consciousness -5%
• Heatstroke (minor): consciousness -10%, moving -10%
• Heatstroke (serious): consciousness -20%, moving -30%, pain +15%
• Heatstroke (extreme): consciousness max 10%, pain +30%
• Heatstroke (100% severity): death

Hypothermia

Hypothermia occurs when a pawn has prolonged exposure to temperatures well below their minimum comfortable temperature.

• Hypothermia (shivering): consciousness -5%, manipulation -8%
• Hypothermia (minor): consciousness -10%, manipulation -20%, moving -10%
• Hypothermia (serious): consciousness -20%, manipulation -50%, moving -30%, pain +15%
• Hypothermia (extreme): consciousness max 10%, pain +30%
• Hypothermia (100% severity): death

Scarring

Scars are permanent markers of injuries. They permanently lower the maximum health of the scarred body part, making it easier to damage the affected body part in the future. They also cause a character a small amount of pain, even if the relevant body part is fully healed. Pain from scars results in a permanent mood penalty for non-masochistic characters. For a colonist with the Masochist trait, scar pain will provide a continual mood bonus instead of penalty.

Scars can be caused by poor quality treatment or simply not treating wounds, though injuries have an inherently low chance to scar, as seen above. Sometimes colonists are generated with minor scars and old gunshots already in place. Some body parts also scar instantly upon injury.

It is possible to remove the pain from some scars by surgically implanting artificial replacements. Artificial body parts will never scar.

Scars can be treated by luciferium, however the cost of using it usually outweighs the benefit, unless used on numerous scars, or a permanent brain injury.

Another way to work around scar pain is to implement a Painstopper, preventing all ongoing pain. The downside to this, however, is that should the pawn with an installed Painstopper take serious damage - they won't go down until they either lose a leg (or have it heavily injured), or die. Therefore, you should be extra watchful of their health as to decide whether to withdraw them from a controllable scenario (i.e. combat), as to prevent them from losing their life.

Heart Attack

Heart Attacks can randomly occur on any pawn/animal at any time, but they become more frequent as they pass half of their life expectancy (e.g. 40 years in Humans), triggered by Birthday event. There must be more than 2 colonists on your colony for this to occur.

The average interval between heart attacks is curved as follows (in days).

0-50% of LE: 99,999,999 - 99,999,999
50-60% of LE: 99,999,999 - 2,500
60-100% of LE: 2,500 - 300

Examples of intervals and chances:
55% of Life Expectancy (e.g. 44 in humans): 50,001,249.5 days (approx. 0.00000002% per day)
80% of Life Expectancy (e.g. 64 in humans): 1,400 days (approx. 0.000714% per day)

Stages

A heart attack has 3 stages.

Painful: 0 - 59% severity

• Consciousness x50%
• Pain +40%

Debilitating: 60 - 99% severity

• Consciousness max 10%
• Pain +60%

Fatal: 100% severity

• Death

Progression

Heart attacks always start at 40% severity. Every 5,000 ticks (1.39 mins) the heart attack severity will randomly change by a value between -40% to +60%. This means that it is possible for a heart attack to treat itself on its own, but usually the heart attack progresses to fatal severity.

Treatment

Like injuries, medicine can be used to treat a heart attack.

Doctors treating heart attacks will administer treatments rapidly, consuming medicine in the process. Each treatment has a chance to succeed, reducing the heart attack severity by 30%. Successfully reducing severity below 0 will completely treat the heart attack.

The maximum chance a particular treatment can succeed is 65%.

Old Age

Main article: Ailments

Strictly speaking, these aren't truly injuries but the result of old age taking its toll on a colonist's body. Chronic diseases are significantly more likely to occur past a pawn's life expectancy. All occurring ages are based on humans, and will obviously be different with animals dependent on life expectancy. Humans stop getting birthdays past the age of 99.

Note that besides the treatments mentioned, all of the below are curable with healer mech serum and luciferium.

Alzheimer's (From Age 36)

• Consciousness
  • -5%/-10% (Minor)
  • -15%/-20% (Major)
• Thoughts will be removed occasionally
• Occasional Confused Wandering, like with Dementia

Artery Blockage (From Age 21)

• Blood Pumping
  • -5%/-10% (Minor)
  • -15%/-35% (Major)
  • -60% (Extreme)
• Death upon reaching 100%
• More Frequent Heart Attacks (on average every ... days)
  • 600/500 (Minor)
  • 300/200 (Major)
  • 120/Death (Extreme)
• Curable with prosthetic heart, heart, or bionic heart

Asthma (From Age 2)

• Breathing
  • -5% (Minor)
  • -15%/-25% (Major)
• Applied to both lungs giving double the harmful effects
• Can be treated, which will prevent progression and limit severity.
• Curable with replacement lungs

Bad back (From Age 41)

• Movement: -30%
• Manipulation: -10%
• Curable with bionic spine

Carcinoma (From Age 25)

• Pain (Note: 30% chance not to cause pain)
  • 10%/20% (Minor)
  • 35%/50% (Major)
  • 60%/70% (Extreme)
• Part Efficiency Loss
  • 10%/25% (Minor)
  • 50%/80% (Major)
  • 90%/Destroyed (Extreme)
• Curable by replacing the affected organ, or surgically removing it if non-essential

Note that Carcinomas always start at 0.3 severity, meaning 20% pain and 25% efficiency loss. The only way a Carcinoma is at its least severity is if it's been in remission for long enough.
This is when below 0.15 severity.

Cataracts (From Age 49)

• Part efficiency: -50%
• Curable with bionic eye and archotech eye

Dementia (From Age 69)

• Consciousness: -15%
• Talking: -40%
• Hearing: -40%
• Occasional 'Confused Wandering' Mental Breaks
• Not curable with luciferium.

Frail (From Age 51)

• Movement: -30%
• Manipulation: -30%

Hearing Loss (From Age 49)

• Part efficiency: -50%
• Curable with cochlear implant and bionic ear

Trauma Savant

Being shot in the brain can cause the trauma savant condition.

A pawn may become a trauma savant upon taking and surviving an injury to the Brain. Certain capabilities will rise and some will fall.

Trauma Savant currently removes all ability to socialise and opinions of others, capability of Talking and Hearing (both capped at 0%), but increases Manipulation by 50%, and restores full brain functioning (meaning consciousness and other functions will be normal) - this is great for doctors and general workers, but it'll make affected wardens or traders a write-off in that aspect.

There is a 12% chance of any pawn becoming a trauma savant upon receiving brain damage. It does not have to be a humanlike, and can sometimes be seen applied on animals.

Trivia

Brain injuries in Rimworld cause large amounts of pain (20% or higher for a 5 hp wound), often rendering a pawn permanently comatose in extreme cases, this being due to pain stacking with the reduced part efficiency. However, in real life the human brain has no pain receptors. This is due to how if anything manages to get into the brain and damage it, it will already have caused intense pain from having to penetrate the skull, and the person is likely going to be fatally wounded regardless of how they react. Headaches are often caused by receptors triggering elsewhere in the head or neck, not by receptors in the brain