Description: Insult to Injury

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Description: Insult to Injury

Post by Greslin »

by Greslin
v1.311 - released 2/15/2018


"Dear Diary,

So one day Pipe and I, badly beaten up from another Gunners fight, are on our way home when we pass this high-walled town in the middle of nowhere. It's surrounded by heavy turrets and a big sign reading, 'Covenant' over a heavy steel door. Suddenly the door flies open and people come rushing out to shoot at - what? - a Stingwing? - okay. The door was open, and we were thinking maybe Covenant might have a doctor, so we go through the door to look for one. Let's just say that it didn't end well. Now I'm a godawful mess: three limbs crippled, a nasty head gash, and what I think is the start of a really juicy infection. And still no closer to finding a doctor.

On a positive note, Piper and I recently came into possession of a very nice little town."


This is a Survival Mode ONLY mod. As of v1.31, ITI systems will completely disengage in any other difficulty.


v1.0 - 2017/04/03 - Initial release
v1.01 - 2017/04/04 - Bugfixes (see comments section)
v1.1 - 2017/04/06 - Bugfixes, infection and sleep reworks, weather effects, rebalancing
v1.2 - 2017/04/10 - Bugfixes, rebalancing
v1.21 - 2017/04/11 - Bugfixes (hopefully last of the major ones)
v1.22 - 2017/04/14 - Bugfixes, added radiation as an infection/healing factor
v1.23 - 2018/01/17 - Bugfixes, primarily re: the Medic perk
v1.24 - 2018/01/23 - Bugfixes, rebalancing, handling for pseudo-interior spaces
v1.25 - 2018/01/26 - Bugfixes, new limb caching system, antibiotics handling
v1.251 - 2018/01/29 - Hotfix release to fix antibiotic system, item values
v1.26 - 2018/01/31 - Minor bugfixes, added descriptions to items in pipboy menus
v1.261 - 2018/02/01 - Hotfix to sort out some event timing issues
v1.3 - 2018/02/03 - First 1.3 dev release, w/new stimpak handler and MCM support
v1.31 - 2018/02/15 - Specific Limb Infection system, many updates and doodads, minor bugfixes
v1.311 - 2018/02/15 - Bugfix, possible CTD


"Insult to Injury" is my attempt to implement a reasonably FNV-like limb damage and recovery system in Fallout 4. It will not be a direct reimplementation of FNV's hardcore system - the best way to say it is, "inspired by" - but I do think that Bethesda severely neglected limb damage in FO4, so hopefully this mod takes a few steps towards rectifying that.

A few of the basic features are: no "a nap fixes everything" sleep-to-heal limb recovery, varying bandages and splints that do different things, disease and infection odds that work directly with Bethesda's hardcore disease system (HC_Manager), and much slower limb recovery that ultimately requires both medical care and plenty of rest (or a doctor).


"Insult to Injury" overrides (without replacing) the limb damage and infection systems in the Survival mode of vanilla Fallout 4. My goal is to create a seamless experience between the two, without having to alter base scripts in the process.

ITI's features include:

* Completely overhauled Stimpaks that restore health in a more complex and nuanced way. (See "Stimpaks", below.)

* Incremental and specific limb health recovery. Limbs do not miraculously and fully regenerate after a nap. They do, however, heal a bit with uninterrupted rest if they don't happened to be crippled. Retreat to a safe place, patch yourself up, and spend a few days resting and working on settlement building for a while.

* INFECTION: In the Wasteland, your risk of wounded limb infection is fairly high. (See "Infection", below.)

* SLEEPING: Sleeping safely will allow you to heal better and more quickly. (See "Sleep", below.)

* WEATHER: If you are outside (i.e., not in an interior cell) in the rain or snow with wounds, you will run a higher risk of wound infection. The longer you are out in inclement weather, the higher your risk gets.

* ALL healing effects introduced in this mod are improved with higher STR and END SPECIAL base values.

* Introduction of bandages and splints. See section below, "Bandages".

* Doctor rules have been unchanged. Get healed/cured by doctors per normal.


Stimpak operation has been significantly overhauled. They are now almost entirely script-driven, meaning that they are NOT compatible with anything else that alters Stimpaks (including most sorting mods). Load ITI at the bottom of your load order or reconcile yourself in FO4Edit.

ITI Stimpak rules are as follows:

1. Starting with a base HP figure, the actual HP you get from a Stimpak shot is calculated based primarily on your END stat. If your END stat is low, expect your Stimpak performance to be low as well. Not taking into account any other factors, Stimpaks should give you 35 to 60 HP.

2. Stimpak HP gains happen over time (up to 60 seconds), but higher STR base stats lower that time to as low as 20 seconds.

3. The Medic perk bumps total HP gain by 25% with each rank, doubling HP gain at Medic 4. Each successive Medic rank requires a higher INT stat, up to INT 8 for Medic 4.

4. Medic 3 and 4 add an overall limb healing factor. At Medic 3, all your wounded limbs will receive a 5% heal. At Medic 4, it's 10%. These healing bumps only apply to minor wounds: only limbs at 80%+ health ever get a Stimpak bump.

5. You can't pound Stims. There's a three hour cooldown after a Stim shot, and if you use a second one during that window, you'll get diminishing returns out of it. Right now, the HP gain for the second shot is cut in half.

6. Stimpaks now contribute to your disease risk. This thing's a dirty needle you found in a ruined building, and you decided to jab it into your arm. Smart you. So every Stim use pushes you further towards an inevitable crash.


v1.24 - Limb damage threshold reduced to 80%
v1.25 - Antibiotics help prevent limb infections
v1.31 - Specific Limb Infection system, all infection risks increased to compensate for MCM adjustment, disease expiration extended from 3.5 to 7 days.

Infection happens when an open wound finds itself home to little bacterial creepy-crawlies that set up shop and have kids, ultimately turning healthy tissue necrotic. As you can imagine, the Wasteland is not a particularly sanitary environment, so the possible sources of infection are many - especially if you're already injured.

In standard FO4 Survival, Infection is one of four random diseases that you can get when your number happens to come up. When it's time for you to get sick, the game literally does exactly that: makes a random choice between infection, insomnia, lethargy, and parasites. The source doesn't matter, so getting sick from a molerat bite can make you insomniac as easily as infected.

This mod doesn't alter any basic Survival mechanics. It only adds some new rules on top of them, and they only involve one disease: infection. Wound infection with this mod happens outside of the Survival/HC engine, in addition to the normal Survival effects.

These rules are:

* For purposes of infection, limbs are considered "wounded" if they are below 80% health. They don't need to be perfect at all times.

* Currently, the infection effect is exactly the same as in vanilla: recurring damage that gets worse as the infection spreads.

* "Insult" infections are not subject to the normal Survival rules preventing overlapping diseases. You can have Insomnia and still get infected.

* While antibiotics work as normal, herbal remedies will have no effect on wound infections. Sorry to tell you, but your cute natural grass pills aren't going to do much against streptococcus. You need penicillin. (See "Antibiotics", below.)

* Radiation over 200 rads reduces limb healing rate and doubles chances of wound infection.

* Generally speaking, trekking in unhygienic conditions with wounded limbs will increase your infection chances. These include sleeping outdoors or on soiled/inferior bedding, swimming, or spending time outdoors in rain or snow (see "Sleep", below). Swimming infection penalties should be nullified when wearing power armor.

* Each of the bandage/splint options (see below) has influence over your infection chances. Generally speaking, sterile and prewar bandages are a lot safer than found, used, or kludged-together materials.

* As of v1.31, the normal Infection disease expiration has been extended from 3.5 days to 7 days.


As of v1.31, there is now a "Specific Limb Infection" ruleset. This can be disabled in MCM. Rules are:

* In addition to general infections, limbs are now also individually infected, and infected limbs will lose health over time until they become crippled. If they remain infected after being splinted/bandaged, they will continue to lose health and will soon become crippled again.

* In general, normal sleep healing should heal a limb more quickly than an infection can damage it. In this situation, however, infection is dramatically slowing down the pace of sleep healing.

* When infected limbs drop to below 20% health, the infection can spread to the next most damaged limb. These checks happen every 12 hours (same as the antibiotic timer), and should only spread to one limb at a time.

* Infections vary in aggressiveness. Aggression is randomly selected on initial infection, and determines how quickly the infection will spread and how much damage it will do. This information is NOT shared with the player. Antibiotics will directly counter infection aggressiveness, in order to slow infection spread between limbs.

Disabling this system in MCM will revert operation to the pre-1.31 infection ruleset.


In standard Hardcore/Survival, antibiotics cure any existing disease that is afflicting the player, including limb infections from "Insult to Injury". In the standard vanilla rules, they also give you a free pass for the next disease event that you encounter.

Taking antibiotics also gives you a gradually declining protection against future limb infections. Default right now is roughly two days, adjusting at 12 hour intervals. For the first 12 hours, you're immune to limb infections, 12 hours after that you're at 75% immunity, and so on until you hit zero.

As stated above, if "Specific Limb Infection" is active, antibiotics also reduce the odds of a specific limb infection spreading. This is done with a separate roll: the first checks to see if a spread is happening, and then the second checks to see if the current antibiotics/immunity level stops it.

Note: These rules ONLY apply to Vanilla antibiotics. Herbals, or drugs created by other mods, do nothing against limb infections.


In vanilla FO4 Survival, limbs heal fully with sleep. This mod makes sleep a bit more complicated.

* Crippled limbs do not heal at all with sleep. In fact, if you sleep with a crippled limb, you take a significant risk of infection.

* If you are diseased in any way - infection, lethargy, parasites, or insomnia - resting limb regeneration rates are cut roughly in half. Get well, then get strong again: not the other way around.

* Bed type and location matter. Sleeping on anything less than a proper indoors bed increases infection odds. Outdoors is bad. Sleeping bags are worse, and dirty mattresses are even worse. An outdoors dirty mattress is just a death wish.

* Being in "pseudo-interiors" - enclosed shelters that exist in the external worldspace, as compared to interior cells - cuts in half the normal penalties for being out in, or sleeping in, the rain. This should include most if not all of the vanilla buildings. If you have True Storms 1.4 installed, that mod's fog filters can be used to designate these fake interiors in workshop and settlement buildings. (Thanks to True Storms author fadingsignal for his help in detecting these spaces!)

* Non-crippled limbs heal a bit with a full night's sleep (6+ hours). The heal rate is percentage-based: the lower your limb health, the longer it will take to fully heal. It's much quicker to go from 75% to 90% than it is to go from 10% to 20%. If you sleep less than six hours or interrupt your sleep, there is no limb healing for that cycle.

* You cannot "chain nap" to full health. Whenever you successfully complete a full night's sleep, you must wait 16 hours before another sleep cycle will heal your limbs at all. (Yes, this means that waiting for serious limb damage to heal can take upwards to a week or longer, which can practically force you to fail certain timed settlement quests. Keep that risk in mind! When you need a little vacation to heal up, look at that as an opportunity to get some work done on your settlements.)

* If you sleep for longer than three hours with any of your limbs at below 5 points of health, you will wake with those limbs firmly crippled. Sorry: you rolled over and hurt yourself. (This IS cumulative with the crippled-sleep infection risk!)

And yes: if you're not careful, you can get sucked down into a death spiral of infection, bad sleep, and brittle limbs. This is NOT a bug. Take care of your health, pack bandages, rest, and don't let a death spiral happen.


Okay, now this is important:


This is the major difference that this mod implements. Unlike in FNV, where you could choose which limb you wanted to apply a stimpak to, in FO4 it just sort of heals everything at once. With this mod enabled, there are ten new healing consumables, and they all have two basic functions: stabilizing a crippled limb, and dressing up an injured and bleeding limb. One or two of them do both, but for the most part, it's one or the other. They also each have different healing ranges and chances of infection.

* If the bandage is a wound dressing, the mod will apply it to the most damaged limb that is a) not crippled, and b) not above about 25% health.

* If the bandage is a splint/stabilizer, it will prioritize the head first, then the legs, then the arms. It will only heal crippling injuries, and even then, usually just barely so. Follow up the split with a wound dressing and some rest.

* If you use a bandage and there is nothing appropriate to heal, you've ruined the bandage/splint. It doesn't currently respawn in your inventory.

* In any situation, the bandage/splint/balm/whatever will only heal you so far (up to about 25% limb health). After that, you need to rest and recover. At first sleep recovery will go fairly slowly, but the rate improves as you get closer to full health.

You can craft some of the bandages, others are rare prewar items, a few you'll find on enemies, and one is a special lore-friendly easter egg for all you old time FNV players.


v1.24 - renamed Combat Dressing and Med-Tek bandages for clarity, buffed Combat Bandage a bit
v1.31 - added new chem station recipes for scrapping dirty/used bandages and making antiseptic from vodka and whiskey

This mod introduces ten new healing consumables.


Wasteland Wound Balm: Dressing only. Made at cooking stations, mainly from local plants and bone meal. Low disease risk.
Combat Trauma Kit: Stabilize or dress. Chem station, good healing. The bandage you'll probably make most. Very low disease risk.
Sterile Trauma Bandage: Dressing only. Chem station, good healing. Low disease risk.
Handmade Raider Bandage: Dressing only. Easy to make, chem stations. Fair healing, fair disease risk.
Improvised Field Dressing: Dressing only. Chem stations, fair healing, fair disease risk.

Not Craftable:

Used Wasteland Bandage: Dressing only. Disgusting but provides a little healing. High disease risk.
Dirty Wasteland Bandage: Dressing only. A little better than Used. Fair healing, high risk.
Med-Tek Trauma Kit: Stabilize or dress. Rare prewar. Excellent healing, very low disease risk.
SAM Medical Splint: Stabilize only. Very rare prewar. Excellent healing, no disease risk.

.. and finally ..

Brotherhood Hydra.

Following the events of New Vegas and the reconnection with the West Coast Brotherhood, the East Coast Brotherhood has obtained small amounts of a new Brotherhood Scribe-synthesized version of Caesars Legion's limb healing drug, Hydra. This engineered version of Hydra is packaged in an X-Cell stim, and upon injection, heals a single limb completely and immediately. Not craftable, and there is only one place in the game to obtain it.

As of v1.31, you can now salvage used/dirty bandages at chem stations, as well as create antiseptic from whiskey and vodka.


The tricky part to writing a mod like this is that, by writing it for other modders, you can't rely on a standard consensus as to what makes a game challenging or immersive. Everyone has a different mix of mods and game tweaks, each built for a unique set of preferences. So rather than try to guess, find an inoffensive middle ground, or simply declare my own tastes good while ignoring everyone else, I'd prefer to give you as much control as possible over how this all works.

Most of the significant internal parameters of this mod are now exposed through Mod Configuration Menu (MCM v1.2+ required). Using this screen you can make this mod as brutal or as gentle as you want, scaling virtually every single process in Insult to Injury.

All future features in this mod will be developed with MCM options in mind, and there are already too many settings available to properly go into here. They are documented in the MCM interface, so if you find yourself stumped with any particular option, ask me in the comments and I'll be happy to clarify.

In general, however, these MCM controls come in three flavors:

1. ON/OFF. Enable or disable specific components of the mod.

2. Thresholds. A threshold is an upper or lower limit that triggers a response when reached, such as a mod feature that activates when a limb hits 80% health or when your rads hit 200. Threshold settings allow you to adjust where exactly those triggers fire.

3. Modifiers. These are scaling multiplier values that are wedged in all over this system. After all other calculations are made for a particular mod feature, the modifier for that feature is applied to scale up or down the final result. All modifiers default at 1.0, which means that no modifier is in fact applied. 0.5 cuts the result in half, while 2.0 doubles it.

Modifiers are usually used here to adjust probabilities on dice rolls, letting you add extra weight to one side or other of the randomizer. Setting a modifier to zero should generally disable that feature, making that particular dice roll either impossible (an affirmative roll) or inevitable (a counter roll).


Both this mod and my Companion Heal Thyself mod owe their mutual genesis to a single bug. I wanted a good limb-breaker mod, but the ones I tried (specifically, No Limb Regen) had a nasty bug that left downed companions unable to be healed with a Stimpak. I stumbled over the solution in coding CHT, and then implemented it as a patch to NLR. That same solution is also part of this mod.

What happens is that, in order to prevent Stimpaks from uncrippling limbs, the archetype value of the associated magic effect has to be changed. Normally it is set to "Stimpak", but unfortunately, that makes it automatically uncripple limbs. Setting it to anything else prevents the companion bleedout recovery step from working.

So what I do in "Thyself", my NLR patch, and this mod, is emulate the companion bleedout recovery step. There's an internal switch that controls whether the companion actor has the power to un-bleedout themselves (as happens in non-Survival play). In Survival, that's almost always set to OFF. My fix gives the companion a few seconds of the ON position when they're hit with a stimpak, then turns it back to OFF again. This gets them off the ground without the need for the Stimpak archetype.

The other issue that tends to pop up is one where sleeping with crippled limbs makes them permanently broken. I was very aware of this issue as I was writing this, and it shouldn't happen with this mod. If anything like that does happen, please let me know so that I can fix it. Thanks!


NO DLCS REQUIRED. F4SE and MCM are required.

Versions prior to v1.3 do not require F4SE, but are no longer being developed.

Unpack the RAR to install, disable the ESP in your load order to disable.


Again, this is for Survival mode ONLY. Compatibility notes are as follows:

* This mod is incompatible with other limb damage mods (No Limb Regen, etc.). Don't do it. However, any limb-recovery health items introduced by other mods - first aid kits, "doctor's kits", whatever - should continue to function unimpaired. This mod doesn't attempt to specifically interfere with other mods in any way. So pick your poison.

* Since this mod now completely overhauls Stimpaks, any other mod that messes with Stimpaks will conflict HARD. When in doubt, load this ESP at the bottom of your load order, or reconcile in FO4Edit to ensure that this version of Stimpaks remains intact.

* I have tested this release with my Companion Heal Thyself mod, and they work fine together.

* As of v1.31, this mod autodetects the presence of True Storms 1.4, automatically installing compatibility support without the need for a patch. The True Storms compatibility features incorporate support for that mod's fog filters, extending the "pseudo-interior" effect to workshop buildings. ITI versions 1.24 to 1.30 require an optional patch.

Mod compatibility statuses (as I test them):

True Storms 1.4:
Compatible. Optional patch adds ITI support for True Storm's fog filters, extending "pseudo-interior" protection to workshop and settlement areas. v1.31+ includes this support natively, with no patch required.
Be Exceptional: Compatible. BE automatically translates its "medicine" skill to appropriate Medic perk assignments.
Horizon: Untested but almost certainly incompatible. If you have any luck using these together, please let me know.
Frost: Untested.
No Pain, No Gain: Incompatible. Alters the Stimpak record in ways that break ITI's Stimpak system.
Wasteland Wound Care: Compatible but redundant. No ITI support for WWC items.
Any item sorting mod: Compatible with load order changes (place ITI lower) or with reconcilation in FO4Edit. Just make sure ITI Stimpaks aren't being overwritten.

Please let me know if other compatibility patches are warranted. Thanks!


Thanks to my wife (Overwatch/Destiny Assist Queen, fellow gamer, console girl, and partner in crime) for tolerating my Fallout fandom.

Thanks to MajorDick for testing and feedback assistance.

Thanks to everyone who has downloaded, enjoyed, and perhaps even endorsed any of my mods for Fallout 4 and New Vegas. I very much enjoy doing this stuff (albeit often in a rather sadistic fashion), and while I know that this kind of mod certainly isn't for everyone, I'm gratified to know that there still are a few folks out there who seriously dig the genre. And so I'll keep writing them.

I have no intention of porting any of my mods to console. I'm a PC player, and diving into the pool doesn't interest me in the least.

This mod is still in early releases, meaning you should expect some bugs and items that need to be rebalanced. Your game saves, however, should be fairly safe at this point. Try it out and leave your feedback in the comments. I want to hear them!