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.
We use Survival Mode Overhaul as the backbone of our survival experience. This system significantly expands the core survival mechanics of Fallout 4 with deeper needs, complex diseases, and tactical companion management.
Explore the Needs, Disease & Companion overhauls
Needs Overhaul
- Dynamic Influences: Hunger and Thirst are influenced by perks (Lead Belly), Endurance, and weight.
- Overcharge Bonuses: “Well Fed” and “Well Hydrated” bonuses boost disease resistance when needs are over-maintained.
- Enhanced Interface: View precise hunger, thirst, and sleep levels in the Pip-Boy NEEDS tab (requires PipboyTabs).
- Sleep Buffs: “Well Rested” provides significant resistance bonuses.
Disease Overhaul
The most complex part of the overhaul, introducing 27 distinct diseases across three types:
- Ailments: Gained from contaminated food/drink or radiation.
- Infections: Gained from taking damage, especially from diseased creatures.
- Mental Issues: Gained from combat stress, killing humans, or Adrenaline spikes.
Risks & Treatment:
- Risks vs. Resists: Track your Disease and Stress risks in the Pip-Boy.
- Progressive Stages: Diseases have 3 stages, worsening every 24 hours if untreated.
- Complex Cures: Antibiotics and Doctors are no longer instant cures. Doctors only treat Stage 2/3 down to Stage 1. Stage 1 requires medication paired with 7+ hours of sleep.
Companion & Combat
- Exhaustion: Downed companions gain exhaustion, lowering their combat effectiveness by up to 50%. Rest or healing is required to recover.
- Adrenaline: Now provides damage resistance (2.5% per rank) instead of a damage boost, making it a defensive tactical resource.
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.
:::tip Healing Strategy 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—it is a lethal poison that accumulates and degrades your body until treated.
View Radiation Poisoning & Medicines
How it Works
Radiation poisoning causes stacked debuffs that worsen over time even after you leave the hot zone. If left untreated, the poison will eventually be fatal.
:::danger Radiation Essentials
- Monitor your Geiger counter: Watch ambient levels and internal poisoning.
- Storm Protection: Gas masks or power armor helmets are required during rad storms.
- Immediate Treatment: Do not wait. Debuffs stack quickly and become deadly. :::
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.
:::info The Survivor’s Kit
- 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: To survive sudden radiation storms.
- Fresh Food & Water: To keep your needs from reaching critical levels. :::