Fallout 4

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About this mod

A hardcore combat and medical overhaul which adds lethal headshots, wounds, bleeding, pain and 12 new medical items. Script free and highly compatible.

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This mod is 100% script free and manages all its effects through perks.
It is compatible with weapon, projectile and ammo mods without needing patches.
Active support given in the MAIM Discord server.
MAIM transforms combat into a brutal and terrifying experience.
It adds a complex injury and healing system, inspired by Escape from Tarkov.
No more running and gunning; you'll need to use tactics and careful resource management to survive.
You can now get one-shot by a lone raider, or bleed to death after fighting off a few feral ghouls.
That said, almost everything is customisable in the MCM, so you can make it as easy or difficult as you like.
Best combined with SCOURGE and True Damage, which normalise enemy health and weapon damage respectively.

  • Damaging a body part to 50% condition causes a light bleed, to 0% causes heavy bleed.
  • Bleeding is indicated by noticiation messages, a blood spatter effect on the actor and light or heavy blood dripping sounds.
  • Bleeding damage is automatically scaled to the actor’s health.
  • Each body part bleeds independently and they stack with each other.
  • Sprinting increases bleed rate.
  • Light bleeds on the player last for 90s if untreated. The timer restarts each time you are hit.
  • Heavy bleeds last for 90s from the moment a limb is crippled, then stop until the limb is healed.
  • Light bleeds can be stopped with a Bandage, Hemostatic Gauze, TXA Injector or by healing the limb above 50% condition.
  • Heavy bleeds can be stopped with a Tourniquet (for limbs), Chest Seal (for torso) or Surgery Kit.

  • Damaging a body part below 50% condition causes mild pain, to 0% causes severe pain.
  • Pain causes periodic blurred vision.
  • Arm pain reduces reload speed.
  • Leg pain reduces movement speed and jump height.
  • Torso pain massively reduces AP regen.
  • Painkillers relieve these effects and heal head condition.
  • Sprinting on injured legs (below 50% condition) damages them further.

Body part conditions
  • Limb shots do less damage to HP*. Aim for the torso or head to kill. 
  • Limb damage multiplier for player and NPCs* is independently adjustable in MCM.
  • Body parts can only be brought out of crippled status by a Surgery Kit, Splint, sleep or by a doctor.
  • Torso condition, unused in vanilla, is now fully integrated (requires Condition Boy to view).
  • A damaged torso causes pain, bleeding and reduced AP regen.
  • Falling does less HP damage but will cripple your legs.
  • When a limb is crippled, it has a small chance to trigger secondary effects depending on the injury e.g. disarm, knockdown etc.
    *Only affects humans, ghouls (non-feral) and super mutants. Feral ghouls are not affected to allow compatibility with other ghoul/zombie mods.

  • Headshots are now lethal if not wearing a helmet.
  • Affects humans, ghouls, feral ghouls (optional), bugs and most animals.
  • Super mutants are partially affected; you'll need to get up close and personal or use an armor-piercing weapon to one-shot them.
  • Pistols have a 33% chance to penetrate a helmet for an instant kill at long range. At close range (within 10m) this rises to 60%. 
  • Rifles have a 77% chance at range and 86% up close.
  • Shotguns can only headshot at close range.
  • Sniper and Armor Piercing rifles will always penetrate helmets.
  • At close range, Gauss rifles have a 50% chance to headshot virtually anything, including power armor, deathclaws etc.*.
  • These effects work by checking equipment for keywords, which makes it 100% compatible with ammo and projectile mods.
  • Most weapon and armor mods will work out of the box without patches.
  • If they don't, you can add the required keywords in-game via the included EZ Keywords patch or manually using xEdit and this tutorial.

  • If you're lucky enough to survive getting hit in the head, you may suffer a contusion.
  • Your vision will black out, your ears will ring and you'll be unable to run.
  • You'll suffer slow damage to HP and AP, as well as stat debuffs.
  • These effects last for a few seconds at a time and will return periodically.
  • Healing a contusion in the field will require a special item: Mannitol Injector. It can also be healed by sleeping or visiting a doctor.

NPC Effects
  • Bleeding and pain effects are applied to NPCs in a logical way.
  • Fully affected: Humans, Ghouls, Feral Ghouls, Gen 3 Synths, Super Mutants
  • Optional in MCM: Animals, Creatures
  • Not affected: Gen 1 & 2 Synths, Robots, Turrets, Essential NPCs (companions)
  • NPCs' bleeds last for 30s, restarting each time they are hit.
  • Stimpaks are more powerful for NPCs and heal their limbs to maintain balance, as they cannot use other healing items.

Medical Items
  • Morphine injector. Replaces Med-X. Alleviates pain for long duration. Mild damage resist. Run on crippled legs. Addictive.
  • Ibuprofen tablets. Alleviates pain for medium duration. Slow healing to all non-crippled body parts. Run on crippled legs. Mildly addictive.
  • Hemostatic gauze. Stops light bleeds. If a body part is injured (<=50%) but not crippled (0%), it will slowly heal them. No effect on heavy bleeds or body parts that aren’t injured at time of use.
  • Bandage. A weaker version of gauze. Common and cheap to craft.
  • Tourniquet/chest seal. Stops current heavy bleeds but leaves the body part crippled. The body part remains immune to bleeding until brought out of crippled status by another item, making them a good choice mid-combat.
  • Surgery kit. Stops heavy bleeding, removes crippled status and quickly heals crippled body parts, but leaves them vulnerable to another heavy bleed if crippled again.
  • Splint. Instantly heals crippled body parts by 1, removing their crippled status and allowing them to be healed by other items. Current heavy bleeds are reduced to light bleeds. Combine with bandage for a cheap alternative to surgery kit. Very vulnerable to getting crippled again.
  • TXA injector. Promotes blood clotting, massively reducing all bleeding for a long duration. Slowly heals non-crippled body parts.
  • Stimpak. Restores HP and regens AP over long duration. Cures most injuries for NPCs as they can’t use the other meds.
  • Field blood transfusion kit. Replaces Blood Pack. Rapidly restores HP, body part conditions and rads. Now the most powerful healing item in the game, but disables running and only works while your weapon is holstered (you have the hold the blood bag up, after all) making use in combat risky.
  • Mannitol injector. Cures contusion and rapidly heals head condition.
  • Liquor. Wine and liquor can be used as painkillers. Use with caution however, as they now cause a hangover, damaging head condition and causing pain.
  • Ca-DTPA radiation treatment kit. Replaces RadAway. Slower but longer lasting. More powerful overall but disables running and only works while your weapon is holstered.
  • Potassium iodide tablets. Replaces Rad-X. More powerful, longer lasting and now provides mild rad removal.
  • Atropine injector. Powerful poison resist.
  • Food. Still heals HP, but only out of combat. Option to disable all food healing in MCM.
  • Doctors. Will heal all injuries, for a fee.
  • Sleeping. Heals all injuries.
  • All items are craftable at the chemistry station with the Medic perks.
  • Medical items are no longer affected by perks that modify magnitude or duration. These perks have been repurposed where appropriate.

  • Medical item do not stack with themselves, but do stack with each other. E.g. 2 Stimpaks won't heal faster than 1, but you can use a Stimpak and Blood Transfusion in combination to heal faster.
  • Meds that heal body part conditions fall into two categories:
  • Locally applied bandage, hemostatic gauze and surgery kit. When first applied, these items make a check of all body parts and only apply to parts that meet their conditions. They stay active until their duration expires, or the affected body part becomes crippled, in which case they are removed.
  • Globally applied: TXA injector, ibuprofen, blood transfusion kit. These items are ingested or injected and will continuously heal all non-crippled body parts for their duration. Unlike locally applied items, they are not removed if a body part becomes crippled; they will begin healing the injured part again if it is brought out of crippled status by a splint or surgery kit.
  • The Tarkov tactic of pre-medding works in MAIM too. Using Painkillers and a TXA Injector before a firefight will minimise the effects of pain and bleeding if you get injured.

Perks and More...
  • Medic perks no longer increase Stimpak or Radaway strength. They now allow you to craft the new medical items.
  • Health regeneration perks, bobbleheads etc. have been changed to give additional health instead.
  • Adamantium skeleton: no longer reduces limb damage. Now reduces fall damage and makes worn armor weigh less.
  • Big leagues: melee damage bonuses increased to maintain balance with firearms.
  • A few perks have had their “chance to” effects (e.g. disarm) removed and descriptions updated. The reason for this is explained under Compatibility: Mods That Use "Apply Combat Hit Spell".

Leveled lists
  • Items are distributed through the leveled lists.
  • The MCM has loot scarcity sliders, allowing you to adjust the rarity of medical loot in real-time.
  • Generally compatible with loot overhauls, just make sure MAIM loads after them.

Required and Recommended Mods
Soft Requirements
  • MAIM is designed to be used with these mods, though they are not hard requirements.
  • Immersive Animation Framework. Provides animations to medical items.
  • Condition Boy. Displays body part conditions on HUD. Note the Pip-Boy does not display torso condition at all, so you will need this to see it.

Recommended Mods
  • True Damage - automatically normalises weapon damage by caliber.
  • SCOURGE - standardises NPC health and removes scaling.
  • FallUI – MAIM's items are tagged for FallUI. You'll see [Aid] tags without it.
  • Condition Boy USEC skin – gives Condition Boy a tactical look like the screenshots.
    Install help: Download USEC v2. Place the BodypartsUI.swf file in Data > Interface
  • Wheel Menu – allows you to browse healing items without entering the Pip-Boy.

Complimentary Mods
  • Fallsouls – unpauses menus, makes healing in combat significantly more challenging.
  • Advanced Needs 76 - a great new alternative to vanilla Survival mode.
  • Sleep Doesn't Heal - does what it says on the tin. Not required if using Advanced Needs 76.
  • _PAHelmetAlways (module from Wasteland Ballistics) – makes power armored NPCs always wear a helmet (don’t download any other files from this mod).
  • Fatigue - Enhanced Combat Realism – Using weapons now drains stamina. The lower your stamina, the more recoil and aim wobble you will experience. Strength and Agility improve your ability to handle weapons.
  • Damn Apocalypse Loot Module - hardcore loot and economy overhaul
  • 4estGimp - AI Edit – script free mod that enhances enemy AI without turning them into aim bots.
  • Pack Attack NPC - scripted overhaul to enemy AI. Superior to non-scripted mods, but may not work well on low-end PCs or with other script heavy mods like Sim Settlements. Available on GreslinGames Discord.
  • Companion Heal Thyself - makes companions heal themselves after combat, without wasting a precious stimpak. Available on GreslinGames Discord.

Compatible: Requires Patch (patches can be found either in the FOMOD installer or under the "Misc" downloads section)

Compatible: No Patch Needed

Incompatible: Overlap in Function
  • Better Locational Damage
  • Frost
  • Agony
  • Wasteland Wound Care
  • Wasteland Ballistics
  • Wasteland Medic
  • Insult to Injury
  • _Balance_

Incompatible: Things That Use "Apply Combat Hit Spell"
  • Any vanilla perks that add a chance to stagger, disarm or knockdown on hit do not work with this mod and have been updated accordingly.
  • Weapon Disarm
  • Immersive Fallout Combat
  • MW Player Hit Sounds and Effects (only the original is incompatible - the Redux version is compatible)
  • Why are these incompatible?
  • MAIM uses a perk with “Apply Combat Hit Spell” to activate its effects when an actor gets hit. This makes it compatible with all weapon and projectile mods. The limitation of this method is that the game only allows one hit spell to occur per hit. If two mods are competing to apply a spell, both mods may fail. This will lead to problems with headshots, bleeding and even Stimpaks.

Incompatible: Others
  • Knockout Framework. Incompatible and known save killer. Do not use. Death Matters is a compatible alternative, though I don't know if it's more reliable.
  • The "Increased Walk Speed" and "Decreased Reload Speed" modules from Arbitration. The rest of Arbitration is fine.
  • Button Lowered Weapons and potentially any other old mods that lower weapons. They can cause weird movement speed oscillations due to using outdated methods. Use MCM Hotkeys instead.
  • Any mod that edits abLegendaryCreatureItem - a vanilla spell that gets added to all characters and is used to add the MAIM perks. Mods that edit this will need to be patched.

Installation and Load Order
  • MAIM and its patches should be dead last in your load order.
  • When first installed, the MAIM plugins will be in the wrong order.
  • It is ABSOLUTELY CRITICAL that you follow this load order or something will break.

Load Order
  • ALL your other mods
  • MAIM Distributor.esp
  • MAIM 2.esp (note this must be below distributor)
  • Any MAIM patches such as Russian Stimpak patch etc.
  • - The End - There should be absolutely nothing below this, except a few rare exceptions such as sorting patches.

  • MAIM can be installed at any time; it does not require a new game.
  • A starter kit is provided in Vault 111 on the table by the baton.
  • If installing mid-playthrough, go to an interior cell and wait or sleep for 72 hours for the leveled lists to update.

  • MAIM does not contain any scripts, so can be uninstalled mid-playthrough with these steps:
  • Uninstall MAIM.
  • Go to an interior cell and wait or sleep for 72 hours for the leveled lists to update.

Please see the MAIM Troubleshooting article.

GELUXRUM for being a lad and running the MAIM Discord server.

Everyone on the Discord who helped with beta testing MAIM 2.
Many thanks to the following for allowing me to include their models:
  • ghostfc3s for the splint, chest seal, gauze and tourniquet.
  • ephla442 for the pill bottle.
  • payl0ad for the surgery kit bag.