Survival mechanics
Fallen World is a brutal experience where staying alive is a constant struggle. Understanding these systems is the difference between thriving and dying.
Fallen World is balanced for Very Hard difficulty. Do not pick Survival difficulty: at Survival, vanilla survival takes over hunger, thirst and sleep, and Ashfall switches its own needs layer off.
Ashfall is our survival and environment overhaul, custom built by our team. It turns the Commonwealth into an environment you have to read, dress for and survive: storms that hunt you, air you cannot always breathe, and a body that gets hungry, thirsty, exhausted and sick. Everything it tracks is shown on the HUD and in the Pip-Boy.
Explore needs, disease and storms
Hunger, thirst and sleep
Three pools climb with game time and hit you in stages (34%, 67% and 90%):
| Need | Climbs | Penalty by stage |
|---|---|---|
| Hunger | +5% per hour | Carry weight -10 / -25 / -45 |
| Thirst | +10% per hour | Action points -5 / -15 / -30 |
| Sleep debt | +2.5% per hour | Healing rate -15% / -30% / -50% |
- Relief: Food, drink and alcohol bring the pools back down. Sleep recovers 12% per hour, and an interrupted night recovers half.
- Waiting is not sleeping: The wait menu does not recover sleep debt.
Disease
Two illnesses, three stages each:
- Fever: Damage resistance -10 / -25 / -40.
- Wasting: Movement speed -5% / -10% / -15%.
You catch them from ambient exposure, wounds, swimming, radiation weather, rain and snow, and tainted food or water. Being hungry, thirsty or exhausted makes you more vulnerable. An illness incubates for 4 hours, reaches stage 2 at 10 hours and stage 3 at 24 hours. While you are sick, a named perk (Fever or Wasting, stage 1 to 3) appears in your Pip-Boy PERKS tab.
Cures: An uninterrupted rest of 4 to 7 hours, or a dose of vanilla RadAway. Ca-DTPA does not count as a cure. A cure gives you 24 hours of immunity.
Storms
Ash Fallout, Rad Firestorm, Toxic Sulfur, Acid Rain and Dust Storm roll in on a cycle, roughly 35 to 90 real minutes apart. Three minutes before most storms hit, the storm dome appears silently on the horizon: that is your warning to get indoors, into power armor, or behind a gas mask. The Rad Firestorm has no dome: during it, distant strikes land on the horizon and a ring of fire closes in. Lethal storms send feral-ghoul hunter packs after you, and the pack keeps hunting after the sky clears until you leave the area or get indoors.
Gas masks
- Filter: Drains only while you wear the mask in contaminated air, about 20 minutes of exposed wear per filter. Press F6 to swap in a fresh filter.
- Condition: Every hit you take damages the mask. Press F7 to repair a broken mask with a repair kit.
- Choking: Outdoors in contaminated air without a mask, you take damage every second. A dead filter or broken mask only halves that damage, and a spent filter doses you with radiation. A full power armor suit protects you completely.
Heat, cold and wet
Body temperature, wetness, wind, shelter, nearby fire and clothing insulation are tracked and shown on the HUD. In the current build these readouts are informational: hypothermia penalties are coming in a later Ashfall update.
MAIM replaces vanilla healing with a realistic injury system. Every wound matters, and traditional “stimpak spam” will not save you here.
View Medical Mechanics & Item Reference
Mechanical Overview
MAIM tracks lethal headshots, arterial bleeding, physical shock, and individual limb trauma. A solid MCM setup is pre-configured to ensure a balanced yet punishing experience.
Healing items do not stack with themselves, but you can combine different items. For example, pre-medicating with TXA + Ibuprofen before a fight provides significant protection.
Essential Medical Supplies
| Item | Primary Effect | Requirements |
|---|---|---|
| SP-1 Stimpak | Gradual HP/AP regen & injury cure | None |
| SP-2 Stimpak | Instant heavy healing (3%/s) | Weapon Holstered |
| Med-X | Treats pain/shock; heals head | Addictive |
| Ibuprofen | Heals head & non-crippled limbs | Mildly Addictive |
| Bandage | Stops light bleeds | None |
| QuikClot | Stops heavy bleeds immediately | None |
| IFAK | Heavy bleed stop + limb restoration | None |
| SAM Splint | Stabilizes crippled limbs | None |
| TXA Injector | Critical wound protection (300s) | None |
Radiation in Fallen World is not just a nuisance. Ashfall turns it into a poison that leaves lasting marks on your body.
View Radiation Poisoning & Medicines
How it Works
Radiation sickness runs in stages, from Minor Exposure at 100 rads to Systemic Failure at 1000. Each stage lowers Endurance, and from stage 2 Strength too, and shows up as a named perk in your Pip-Boy.
Ashfall splits radiation into two pools:
- Rads: Ordinary radiation. RadAway clears it.
- Tissue damage: Builds from continued exposure and is not cleared by RadAway. It heals only while you stay under 150 rads.
High tissue damage costs you carry weight, healing rate, speed and action points, and makes you take damage faster. Above 200 tissue damage, your body starts to scar: that maximum health is lost until you are treated with the chelation compound.
- Monitor your Geiger counter: Watch ambient levels and your tissue damage.
- Storm Protection: Wear a working gas mask or a full power armor suit during storms.
- Get Clean Early: Tissue damage only heals while your rads are low. Treat radiation before it starts to scar.
Radiation Treatment
- Ca-DTPA: Rapid radiation removal. Replaces Radaway. (Requires Weapon Holstered)
- MutAway: Gradual healing of radiation damage.
- Potassium Iodide: Provides +200 RAD resistance. Replaces Rad-X.
- Pb-Jelly: Environmental radiation resistance.
- Antibiotics: Essential for treating infections picked up in the wasteland.
- Bandages & QuikClot: To stop bleeding instantly.
- TXA & Ibuprofen: To pre-medicate before expected combat.
- Ca-DTPA & Potassium Iodide: To navigate radioactive zones safely.
- Working Gas Mask, Spare Filters & a Repair Kit: To survive storms and contaminated air.
- Fresh Food & Clean Water: To keep your needs low and avoid catching an illness.