Triage: Patterns of Damage

This is the first in a series of posts about triage – making critical healing decisions when things start falling apart.

One of the things that interested me most about leveling my second healer was experimenting with healing on a class that felt a wee bit clunky to me, or was lacking in the tools I was used to as a disc priest (anything preventative for instance), or was simply undergeared running heroics.  I developed a much better appreciation for the intricacies and patterns of damage taken in a five man.  Raid bosses can follow a myriad of patterns based on mechanics, but in five man dungeons – whether you are on regular or heroic modes or leveling or at 80 – there are a couple basic patterns that damage tends to take. This post is aimed at developing a strategy for five man healing on a new healer, adaptable to any circumstances, level, or class*.  My goal here isn’t to shove defined rotations at you, but to give examples and help you think about noticing how damage happens, and figuring out which tools you have work best to handle it within your style of play.

With experience, if you pay attention to the shifts of those pretty green bars on your screen, you can get good at predicting how the pull will go fairly quickly – in a couple seconds.  Just try not to stand in the Evil Puddles of Doom while doing so.  :)  Obviously, in an ideal world we would know our companions in battle, the pulls, the bosses, the mechanics, as well as that Weird Pool of Slime, like the back of our hand.  This isn’t a replacement for that knowledge.  But often we end up in pugs with players of dubious gear and experience or the random dungeon of the hour is Gnomeregon  or some such instance it used to be all but impossible to convince a group to go to.

Here are a couple examples of patterns you might notice:

  • The tank is taking a bunch of damage (either  a boss or a pile of hard hitting mobs), and the raid is taking very little.
  • Everyone/most of the group is taking AOE/effect damage and the tank is doing okay.
  • One dps is dropping like a stone.  (Generally this is because they pulled aggro or are standing in fire.)
  • No one is really taking any noticeable damage.  (Congratulations your group outgears the content to the point where strategy is the equivalent of walking five miles in the snow to get to school.  Try to stay awake until Cataclysm.)

Here is where I start developing a strategy:

The Pull

The first thing I do with a new healer is figure out what I can do in the worst case scenarios; after that everything seems to fall into place.

Errrr….well…  Okay, the first thing I do is figure out the default opening move.  Depending on your class, this might be preventative measures you do before the pull, or it might be the first couple spells you cast while figuring out how the pull is going.  For a Priest this is throwing up a Shield and a Prayer of Mending on the tank before a pull, and a Renew after.  For a Paladin this could be setting your Beacon of Light before a pull, and applying a Flash of Light/Holy Light/Holy Shock as is your preference.  For a Druid, this is starting your Regrowth cast as the tank is charging, and HoTing him with a Rejuvenation.  For a Shaman, it’s setting up your Earth Shield in advance, and throwing out a Riptide or Lesser Healing Wave. Find something you’re comfortable with that is versatile and mana efficient – you’ll be doing it often.

Indicators of Damage Patterns

Your opening move should become routine fairly quickly and you’ll start to do it without thinking.  As the pull begins, watch key indicators for signals of how it will continue to progress so you can pick the best strategy for triage.  Like what?

  • Watch the tank’s health.  Trust me, this is the first thing that can go wrong.  If you are two GCDs (global cooldowns, i.e. a couple seconds) into the pull and the tank is less than 50% health and dropping like a stone, implement Project Save the Tank immediately.
  • After that, keep your eye on aggro.  (Make sure you can see clearly on your unit frames who has the attention of the Evil Guys; this is critical to making triage decisions.)  It’ll let you know how well the tank is doing and/or how badly the dps is doing at keeping the mobs on the right target, as well as giving you advance notice of who is about to get eaten alive.
  • Next, keep your eyes on the rest of the health bars.  If everyone is taking damage and the tank seems fairly stable, implement Project Save Everyone.
  • If one dps is getting his ass kicked, consider Project Rescue the Suicidal DPS
  • If you are the one who’s face is getting nomnomnomed by the local bestiary, implement Project Fail
  • If everything is going smoothly (yay!)  keep an eye on the tank, and try not to fall asleep.

Project Save the Tank

As I mentioned above, my gauge for this decision is where the tank’s health is and how quickly it has dropped in the time it takes me to complete my opening move.  If it’s down less than 30%, I proceed to regular tank healing and then watching out for the rest of the group.  If it’s less than 50% that quickly, there is a dire problem. Hopefully the tank is using her cooldowns…but you might want to use yours.  Don’t be afraid to use your Pain Suppression, Guardian Spirit, Hands of Divine Paladin Helpiness**, etc on cooldown to help out.  After that, Priests can Penance, Druids can Swiftmend, Paladins can Divine Favor + Holy Shock + an Art of War instant Flash Heal, and Shaman can Riptide.  For a Druid or Shaman, Nature’s Swiftness + Big Heal is another option.  Follow this up with a big or fast heal as appropriate and continue until the tank is stable.  For a Druid specifically, once I realize the tank is this terribly squishy I aim to fit in a Lifebloom once before I Swiftmend, because then I can get the bloom to happen while/right after casting my follow up direct heal, creating a nice chain of heals to eat up just about any damage (i.e. Regrowth, Rejuvenation, Lifebloom, Swiftmend, then Wild Growth and Nourish).

With appropriate gear and cooperation, things shouldn’t get this bad this quickly.  but there are lots of reasons why it might.  I highly suggest looking in to them if you have a couple pulls in a row go badly and/or an early wipe on trash.  Here are a few reasons (but not an exhaustive list of why) this might happen:  Your tank is not speced for tanking.  Your tank isn’t in the appropriate stance.  Your tank isn’t defense capped/wearing dps gear/inappropriately geared for the content.  Your tank is not using his cooldowns effectively.  Your tank is pulling way too much/too quickly.  If you yourself are still working on your gear and technique, this is a bad combination and you should politely ask her to move more slowly.  Some of these are easily addressable (/w Tank Hey! FYI I noticed you aren’t in defensive stance/righteous fury/frost presence/bear form :) ) and some of them just aren’t easy to fix.  In that case, watch your tank like a hawk and utilize every cooldown you have.

Project Save Everyone

This can be scary if you don’t have great AoE tools (or amazingly easy if you do), particularly in a lower level instance when it jumps out of the darkness and clobbers you with a stick.  If you have an AOE cooldown – use it.  Divine Hymn and Tranquility rock for this.  Try to anticipate the damage is coming.  Pre-HOT  group members with Shields and Rejuvenation/Renew.  If you have them, time Circle of Healing, Wild Growth, and Chain Heal for just after the damage hits.  If you’re trying to play catch up, use any of the above on cooldown plus Prayer of Healing. Then follow up spreading HoTs and quick heals around as needed.  If you are a Paladin, pray.  I mean…make sure Beacon of Light and Sacred Shield are on the tank, and heal everyone else in turn. For Shaman, Chain Heal and the occasional Riptide are your best friends. 

Another reason you might shift into Project Save Everyone, is when you have a tank who is just plain bad, or  dps who are just bloodthirsty monsters.  Try to save them.  But when you recover or wipe, try to figure out what went wrong.  If the tank can’t hold aggro against a wet noodle (i.e. if you are pulling it off him)  it’s probably his fault.  Talk to him, but you’re generally going to have to replace him if it’s not obviously a dps issue.  If it’s a Uber DPS vs undergeared/under-experienced tank, ask them to back off a bit.  Yes you.  Healers have a remarkable amount of sway in the social dynamics of a five man.  Really. If you know what is going wrong try whispering the person in a friendly way, then call it out politely, and finally ask the group as a whole to resolve it.

Project Rescue the Suicidal DPS

This is optional.  No really. Sometimes in war there are casualties.  You cannot save everyone, particularly not That Guy lounging in the Dark Puddle of Doom in Gun’drak, lost in his rotation of Arcane Blast x3 and Arcane Missiles and refusing to move or Ice Block.  If a dps is actively trying to kill himself, even after gently warning him, you often can’t save him and preserve the rest of the party.  Think of the greater good here.  I’m not trying to advocate letting anyone who makes a simple mistake die out of revenge…but don’t put into question the health of yourself or the tank, or even the dps who are behaving to save them.  They have Health Potions, often Healthstones, and almost every dps has appropriate cooldowns to use (whether they are of the pretend I’m not here, threat reduction, damage reduction, paralyzing/fearing mobs, invulnerability, or movement variety).  Hybrid dps can even heal themselves in an emergency.

Also realize that if they pulled aggro and die anyways after you heal them….that Big Guy with an Axe nomnoming on their face is probably standing right next to you – not the tank.  Oh look!  Tasty Squishy Flesh! And suddenly, you’re so frantically healing yourself while running back to the tank, and everyone dies.

Save them if you are sure you have the GCDs and mana to do so safely.  Otherwise, try not to cringe as they jump off the roof of the building.

Project Fail

This is not the most “sensitive” or PC name for a scenario, but if you are having issues with Mean Things Trying to Eat You, something is terribly wrong.  The occasional stray mob is realistic, but if you are doing everything right and are getting hit in the face for an extended period of time or on several pulls, it’s a good sign that there’s some version of tank/dps fail going on.

Of all the situations I’ve described, this requires the most intuitive lightning quick perceptions and judgments to execute effectively.  This is the moment that separates an amazing healer from some guy spamming one heal.  You want to have a panic button ready for this moment.  You cannot heal anyone (or even res anyone) if you can’t survive, so that’s where you start.  Make a macro and keep it close at hand.  Put every single thing your class/spec/race has as an aggro reduction or defensive cooldown in it, add /use Healthstone and top it off with your best instant heal.  An extensive list of such cooldowns is a topic for a post in itself, so I’ll just say that this is worth researching on your own. If all hell breaks loose, you can’t click five different buttons – each engaging a GCD – hoping to save yourself, you need to run towards the tank instantly, and press one panic button as you are moving there.

After that?  Continue healing yourself and the tank until you are convinced you’ll both survive.  Then shift to Project Save Everyone if you still need to catch up.

If you are a druid or a shaman you have another option when things start to go badly – whether to use your in-combat resurrection.  Both of these are nifty tools, but they are on long cooldowns. so be careful you’re using them well.  As a shaman, consider the chances the group has without you.  If the boss is at 5% health and the shadow priest stepped into heal, you don’t need to waste your cooldown to save the day.  If your entire group is quickly becoming extinct and there are two members at 5% health, just wait until they die and get yourself up so you can res them and get back to smiting evil faster.  As a druid, consider how badly things are going, and whether you can even keep the tank up if the rest of the group lasts long enough for you to cast Rebirth.

After it’s all over, consider where things went wrong.  Did you pre-cast a HoT or cast a heal in the middle of a pull or before the tank set his threat?  If so, this might be your own fault – apologize and give the tank a little more time to pick up the mobs (unless his life is precariously low).  If you don’t believe me, try this once (after warning him) with a tank who loves you just to see how easily a mistimed heal will draw mobs to you like a hive of bees to the first spring flower.

Wait….None of These Things are Happening…

Congratulations!  Any other circumstances aren’t urgent.  Stay on your game, but you can combine your success with the above techniques to seamlessly address anything falling in the middle.  If you are dreadfully bored and overgeared, challenge yourself.  I know a number of people who shift into their dps spec to heal while dpsing the boss.  (Holy Nova dps FTW.)  Personally, I like the flexibility of picking up the healing in an emergency.  (Exception: if anyone geared is doing less than 2K dps in an heroic, I enjoy kicking their ass on recount while healing.  Sue me.)  If I want to challenge myself in a non-demanding heroic, I’ll randomly pick two spells and try to heal the whole instance using nothing but that.  Then I’ll do the next one with two completely different spells.  Bonus points if one of them isn’t something you use often.  Alternately you can pick a spell you don’t use and force it into your rotation as much as possible or avoid using your most loved spells (Rejuvenation and Wild Growth for instance) and see how that changes the results.  This kind of challenge not only keeps me on my toes, but it can give me a new perspective on utilizing a button I’m not used to using as well as I could  be.


With very few exceptions, these patterns seem fairly consistent for any five man content in the game – until ICC.  (If you have any clear exceptions I haven’t noted, please let me know.)   However, the Icecrown dungeons are a different animal altogether.  While these are just simply harder to heal than other heroics without gear from raiding…Blizzard seems to have changed the rules a bit as well.  But this post is already long enough.  I’ll talk about that some other time.

*I like to think I’m fairly knowledgeable about Priests and Druids.  But some of my suggestions for Shamans and Paladins are informed, but not based on loads of personal experiences.  Feel free to comment if you have better ideas.

**Kurn presents Details of Paladin Awesomeness in comments.


~ by ecclesiasticaldiscipline on June 20, 2010.

3 Responses to “Triage: Patterns of Damage”

  1. Hands of Divine Paladin Helpiness

    Hahaha. :) Well, for a pally, there’s:

    – Hand of Sacrifice. When casting it, it transfers 30% (or 35% or 40% depending on if you have any points in Blessed Hands) of the damage that person is taking to you. Best used if you Divine Shield (bubble) FIRST and then hit this. (Baseline to all paladins.)

    – Divine Sacrifice. If specced for it (17 points in prot for Divine Guardian, which affects Divine Sacrifice, which is available at 15 points), this acts as a raid-wide damage reducer with extra helping out on your party. This is ALSO best used with Divine Shield, although they assure us that we won’t die from this redirected damage these days, you’ll absorb more damage from your group if you’re bubbled.

    – Lay on Hands. As a holy paladin, glyphed and properly specced, LOH is on an 11m cooldown and, unlike its previous incarnations in pre-BC and BC, does not use all of your mana. In fact, it doesn’t use ANY of your mana. This does get mirrored by Beacon of Light, so if you and your tank are about to eat the big one and your tank is Beaconed, cast it on yourself and watch you and your tank suddenly be magically out of the danger zone.

    – Hand of Salvation: Cast on an overeager DPS to reduce their threat. Or, just let them die. ;)

    – Hand of Protection: Cast on yourself if Divine Shield is down and you need to be protected from physical damage. Or any clothie/caster. While you can still cast with this on, you cannot physically attack, either with a bow/gun/crossbow or with your melee weapon. Also, because you are immune to physical damage, only those mobs who DO physical damage will turn away from you. Those who do only magical damage will keep kicking your ass.

    After that, Priests can Penance, Druids can Swiftmend, Paladins can Holy Shock, Shaman can Riptide.

    Pallies should probably Divine Favor, THEN Holy Shock, THEN Flash of Light. Divine Favor will force a crit. Holy Shock crits, when properly specced, will proc an instant Flash of Light (2/2 Infusion of Light) and generally, you can get that combination cast fairly quickly. If Divine Favor is on cooldown, you might just want to cast Holy Light (especially if Light’s Grace is already up and so is Judgements of the Pure) because, depending on your spell haste, it MIGHT be faster to cast Holy Light vs. Holy Shock/wait for the GCD/FoL cast.

    For shammies, I’d just like to add that once you Riptide, you’ll have Tidal Waves up, so you might want to follow with a hasted Healing Wave and a more-likely-to-crit Lesser Healing Wave right after, before Chain Healing the group and then sprinkling critty LHWs around. :)

    As to Project Save Everyone:

    If you are a Paladin, pray. I mean…make sure Beacon of Light and Sacred Shield are on the tank, and heal everyone else in turn.

    … Sadly, this is pretty much the size of it. Bubble yourself and hit Hand of Sacrifice on the tank to help while you focus on the others, or use your bubble and then Divine Sacrifice. If you can’t, though, or you’re going to lose someone, do not lose the tank, do not lose yourself and prioritize either the top DPS or the DPS class who has been kind in helping you with debuffs if they’re being used in that encounter where people are falling over (ie: shammy w/ cleansing totem, druid who is abolishing poison/decursing, mage who is decursing). It matters much less to lose a rogue doing less DPS than the tank than to lose a 6k DPS hunter. ;)

    Excellent post! :)

    • I’d considered walking through all the Paladin cooldowns, and thought it would just overwhelm the rest of the post. I probably should have researched a resource and linked to it for further details for curious Pallys; but now I know that for next time. I definitely should have mentioned Divine Favor and Art of War, and will update the post soon to reflect those suggestions.

      Also, a completely unrelated cartoon just for you. :) I’m glad you enjoy reading and I always appreciate your feedback.

      • All our cooldowns are pretty much silly and overwhelming; I don’t blame you for simplifying at ALL. :) I’m not terribly sure if there’s an adequate resource out there for all of our utility spells. Hm.

        Divine Favor is a huge help, although a lot of people forget it even exists. As to Art of War, remember that’s ret only. :)

        Hee, hee, more xkcd. I love the alt text on the image. I present you with my favourite one ever:

        My best friend’s now a doctor and used to be AWESOME at getting Nintendo games to work, so it rang true. ;)

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