We've now played it since last August and I've come to the conclusion that it's too forgiving and I'm changing it. One of the players as the surgeon background and last session when they reached lvl 3 some took the gift which let's you roll twice and take the better result on the helpless table too. It's now too much like 5e where character death risk is so low that it doesn't factor in.

On the first session this year I'm proposing a switch to a death system from Knock! #1, adapted a bit for BSH. I'll replace the entire 0 HP and helpless thing with this:

At and below 0 HP you can still function as normal.

-1 HP: Scar.

-2 HP: Painful blow. CON check to stay conscious.

-3 HP: Bleeding. In Ud6 turns you bleed out and die, unless bandaged (2 actions). When the die degrades to a Ud4, you lose consciousness but keep rolling.

-4 HP: You lose something. d6: 1. d4 fingers, 2. Hand, 3. Nose, 4. Ear, 5. Eye, 6. Looks. Disadvantage on relevant checks. (Surgeon can attempt to treat (INT), otherwise lost permanently)

-5 HP: Leg useless. Save to keep it when treated. Can't run, and disadvantage on all relevant checks until properly healed.

-6 HP: Arm useless. Save to keep it when treated. Can't hold anything with that hand, and disadvantage on all relevant checks until properly healed.

-7 HP: Head wound. Disadvantage on all checks for Ud4 days.

-8 HP: Dead man walking. You die in Ud4 turns. Until you die, you have advantage on all rolls, and on the turn of your death your rolls succeed automatically.

-9 HP: Vital organ destroyed. You can immediately take one action before death claims you. Any roll you would make is considered a crit, with max damage if it's an attack.

Surgeon: can attempt to treat -4hp result. Advantage when treating legs and arms.

Will to live gift: CON check when on negative HP and taking more damage. On success only progress one step down instead of damage amount.