So, I've always had an issue with healing in D&D 5e. The game is a lot easier on character mortality than in previous editions. In particular, long resting makes surviving easy (the video below sums it up for me). This is NOT me complaining about the game mechanics... I've been running 5e for years, and the long rest mechanic is intrinsic to the game's enjoyability. No arguments here.

Still, I have to ask myself: if long rest fixes everything, shouldn't our D&D worlds be pretty much utopias? Long rests do not fix things like disease and poison, but complete healing over a long rest is miraculous in and of itself. Let me put it like this:

Your characters enter a town that has just been raided. Fences smashed, windows shattered, livestock loose, and people are down and wounded. You can smell the blood on the air. The magical healers in your party immediately go to work, expending their spell slots to heal. But why? Except for those who might be dying (i.e., at 0 hit points and failing death saves), no magic is necessary (and even then, healers kits are all that is really necessary to keep someone from dying -- no magic needed). The people simply need a night's rest. Everyone will be perfectly fine in the morning!

So, my question... how do you deal with NPCs and healing in your worlds? Do different rules apply to NPCs? Are hit points more of a "stamina system" for how much gumption characters have before they have nothing left to give? Do you have other thoughts?

For starters, this will get the response from many that Hitpoints are abstract, and losing hitpoints does not mean taking physical damage. A commoner who is exhausted from dodging attacks and scuffed from glancing blows would be considered at 1hp - the next attack that hits them is going to finish them off.

As such, I would say that NPCs who "need healing" are either at 0hp, or suffering wounds which, for roleplay reasons, will continue to damage them until 0hp.

So a long rest healing up 100hp on an adventurer is not healing up wounds which would have felled 25 normal commoners, it's them recovering from the scratches and scrapes and near-misses and burns which have knocked them down to the point where it won't take much to actually mortally wound them, IE drop them to 0hp.

So in your example, anyone walkign around (at 1-4hp) would not be injured enough to warrant healing. They will stand a better chance of surviving an attack tomorrow, after they rest and regain their strength. The ones needing healing will be ones who are actually going to die if they don't get it.

Regarding making a rest a little less insta-heal, I am considering making the long rest so that it lets you roll all remaining hit die and heal that much. If you've been short resting and healing a load, you'll have less to heal with at the long rest, meaning hard days hurt more. Then all your abilities come back, along with spell slots and hit dice. This should mean that one whole day of not actually being involved in combat will get you back to full hp (or thereabouts), but if you keep going day after day, you might find your hitpoints are going down and down. I might even remove the con modifier from regained hit points, so it has a little more impact, but I'd have to see it in action!

The way I fixed it was to make a long rest reset all Hit Dice to full, but only refresh half max HP. That lowers the amount of healing a long rest does and encourages short resting.

HP tends to be more of the superficial damage, with serious injuries treated more as a story item.

This touches on something that has always bothered me: the Lingering Injuries table in the DMG. All of these effects are either "any magical healing fixes it" or "you need the Regenerate spell to fix it". So it's either a minor inconvenience any party can fix with minimal issue, or you're completely unable to do anything about it until the likely end of the campaign. Some granularity would be appreciated...

Quote from OverdesignBob >>

HP tends to be more of the superficial damage, with serious injuries treated more as a story item.

This touches on something that has always bothered me: the Lingering Injuries table in the DMG. All of these effects are either "any magical healing fixes it" or "you need the Regenerate spell to fix it". So it's either a minor inconvenience any party can fix with minimal issue, or you're completely unable to do anything about it until the likely end of the campaign. Some granularity would be appreciated...

I actually released some more granular rules for this very thing, check my dmsguild release thread if you're interested!

In an action movie, the hero has been beaten, stabbed, shot, thrown off tall buildings, but they haven't yet gotten to the big bad, and now here comes another set of goons.

They buck up, kick butt, then lean back and make faces or grab some powder to pour into a wound or shove a wad of cotton into a bullet hole or grab a bottle of magic pills and bam, they are off to the final fight.

That's hit points.

The video plays on the trope of D&D isn't reality, but everyone sorta treats it like it is supposed to be in a lot of ways, lol. 

If John McClane can run, slide, and fight across a floor of broken glass and then still have half a movie before he drops Gruber, then D&D characters can freaking recover all their hit points in a long rest.

When anytime in my campaign an NPC require healing, it's pretty much handled like characters, with long rest, short rest, hit dice potions and spells to regain hit points. The only real difference between them is that most NPC die at 0 hit points instead of making death saving throws. Otherwise hit point recovery is pretty much the same.

Quote from AEDorsay >>

In an action movie, the hero has been beaten, stabbed, shot, thrown off tall buildings, but they haven't yet gotten to the big bad, and now here comes another set of goons.

 Meanwhile your typical goon gets kicked, or even just gets another goon kicked into him, and he's down for good.

Don't try to impose adventurer rules on the whole world, because they are different. You can explain it however you want - they are backed by a deity, they have unique heritage, they are mere vessels of destiny, whatever - but don't try to extrapolate to the commoner. They just aren't the same.

Quote from scatterbraind >>

Quote from AEDorsay >>

In an action movie, the hero has been beaten, stabbed, shot, thrown off tall buildings, but they haven't yet gotten to the big bad, and now here comes another set of goons.

 Meanwhile your typical goon gets kicked, or even just gets another goon kicked into him, and he's down for good.

Don't try to impose adventurer rules on the whole world, because they are different. You can explain it however you want - they are backed by a deity, they have unique heritage, they are mere vessels of destiny, whatever - but don't try to extrapolate to the commoner. They just aren't the same.

 
Exactly!

Which is why when they encounter that goon again later on, and he remembers them, especially that tall blonde one, every player at the table will totally stop whatever they are doing and try to remember the goon they killed back when.