In line with my post about house-ruling death and dying, this is my house rule for Second Wind in Fourth Edition Dungeons & Dragons. There’s a decidedly more “action hero” slash “heroic fantasy” feel about fighting until you’re down, and then gaining your second wind by defeating a foe. The main differences come in when you look at this in conjunction with the wounded status effect.

If it reads like the Borderlands “second wind,” that’s ’cause the game is the direct inspiration for it. The main difference is this second wind is limited by the previous per-encounter basis. If you decide to use it, and then go down for the count again before your next short rest, you’ll need to scramble some first aid or something.

Second Wind [Survival, Healing]
Standard action (Encounter power)
Requirement: You must have at least one unspent healing surge.
Effect: You spend a healing surge and regain hit points equal to your surge value. You get a +2 bonus to all of your defenses until the start of your next turn.
Special: If you are wounded and you defeat an opponent with an attack power on your turn, you may choose to immediately take a free action to expend your second wind and gain its benefits.

So, it’s important to look at the bloodied status effect and keep in mind that it has no inherent effect. Honestly, the wounded status effect has nearly no effect other than to force those hateful, hateful saving throws against helplessness. On a technical level, being wounded isn’t much different from being bloodied, or even being fit as a fiddle.

You could almost say that the last hit point is the only one that matters. Because nothing technically impedes your character when they’re only three hit points away from helplessness. And suddenly they’re down. The point isn’t that there isn’t a difference between when you’re fighting bloody and when you’re fighting bruised.

Now, in addition to second wind, characters have this power:

Emergency Aid [Survival, Healing]
Swift action (At-Will power)
Requirement: The subject must be wounded.
Subject: You or one adjacent ally.
Effect: The subject may take a free action to expend its second wind and gain the associated benefits.
Special: If the subject has already expended their second wind, and they have at least one unspent healing surge, they recover their second wind and immediately expend it as described above.

Please note that for the above power, you don’t need any training in any special skill to use it. You can just use it. At will. And you don’t have to roll any dice.

The above power came from one of my assertions (“Roles, Skills, Actions”) that helping an ally should be free and easy. The game should never make the choice to help an ally a bad tactical decision. Not on purpose, anyway. It’s different if said your ally is Leeroy Jenkins, but then the fault lies with the player, not the game.