The reason I have been so absent is because I've been slogging painfully through how to make combat balanced and enjoyable in more ways than just pwning the other guy.

In specific, I'm trying to figure out whether I should go with SS13-style health, a complex, DFlike wound system, or a combination of both. If the latter is included, how can I make sure it won't send players into a death spiral, where wounds make it unplayably difficult to avoid taking more damage?

So far, it's worked like this: All toxic damage, and minor damage in other categories, reduces your HP bar a la SS13, where Health is a function of your maximum health, minus the damage you've taken in various ways. This is a simple way to both have a health indicator and have damage healed in different ways.

Every so often, taking a major bit of damage, or being in combat in general, will give you a wound. The effects of this, besides blood loss, are delayed for about 30-45 seconds to prevent it from seriously affecting the combat or other situation you received it in, much like the grace period after hitting an enemy in a platformer. After the delay, the damage and pain of the wound rise to reach the base values for the wound type (These are already determined when you receive the wound, and have a bit of randomness thrown in, but for the same type of wound, the values will be similar.)

To heal one of these, you first need to remove any objects in the wound, like a bullet, stray rivet, or chunk of material that broke off inside. Wounds that heal with an object in them, even properly healed, will require surgery later if you don't want a small chunk off your health bar for as long as your body has the object in it. Then, apply the item or items that will treat the wound itself. For things like a gash or bullet wound, these will usually be stitches. Burns require ointment in this step.

Next, apply disinfectant. This is currently abstracted in the form of a disinfecting cloth, but later I might make it a chemical effect. The disinfectant stage could be considered optional, as could the treatment itself since wounds heal on their own after a bit, but untreated wounds hurt and bleed, and wounds without antiseptic applied have a significant chance of infection, making that two times worse. The last step is to apply a bandage. This step on its own reduces the chance of infection, and with antiseptic, the chance becomes almost zero. After all this, the wound is now greatly reduced in severity, and won't get worse when it finally does heal. Note that all these steps are modified by the healer's medical skill, especially removing objects from a wound.

So in conclusion, yay for updates.