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Extreme Survival are extra rules for your F.I.S.T. game, ones that will add some extra drama and excitement!  PCs don't die instantly at 0 HP and instead take some sort of injury or scar. This not only can add some wonderful opportunities for roleplay, but can even create story threads, as the PC who had their arm cut off, might want to start looking for a way to get a cybernetic prosthetic!