Project Zomboid First Aid Guide: Wounds, Stitches and Levelling in Build 42

Quick answer

Every injury sits on a body part in the Health panel, and the wound type — not the body part — decides the treatment. Zombie-caused wounds additionally roll for the Knox virus the moment they are applied; wounds from glass, falls, fire and tools never do.

Two consequences follow from that table. First, a scratch from a window frame and a scratch from a zombie are the same wound with different stakes — treat both properly, but only one of them can end the run three days later. Second, pain, bleeding and health loss are managed per wound: a character with three untreated minor wounds can be in more danger than one with a single stitched deep wound.

Medical actions are done from the Health panel, right-clicking the wound or using the item on the body part. The order matters because later steps are blocked or wasted when earlier ones are skipped:

1. Stop life-threatening bleeding first. A deep wound can wait a minute; a body part pouring blood cannot. Bandage the worst bleeder even before you have disinfected anything.

2. Remove lodged glass. With glass shards in the wound, the Stitch option does not appear at all. Use tweezers, a Suture Needle Holder or another glass-removal tool; bare hands always work but take longer and add more pain.

3. Disinfect. Alcohol-based disinfectant, rubbing alcohol or other valid alcohol items clean the site and cut the chance of an ordinary wound infection. It can add short-term pain, and on its own it pays no XP.

4. Stitch deep wounds. Use a Suture Needle, or a sewing needle plus thread. First Aid level quietly matters here: stitch quality improves as the skill rises.

5. Bandage with a clean or sterilized dressing. This is the step that locks in the earlier work — and the one most often done badly, with whatever dirty rag is closest.

6. Monitor, then remove stitches. Watch the part for an Infected Wound flag, replace dressings as they dirty, and remove the stitches from the same panel once the site has improved. At First Aid above 6, the panel can show cues that a stitched wound is ready.

Not all dressings are equal, and the gap is large enough to change outcomes:

Sterilizing is a crafting step, not a stronger bandage: a clean Bandage or Rag becomes its Sterilized version with 0.1 L of Rubbing Alcohol, Vodka or Whiskey, or with a kept container holding 0.5 L of water that is already very hot. The sterilized dressing disinfects the wound at the moment it goes on — that application effect is the whole point.

Dressing hygiene is a repeating loop. Bandages dirty over time as they work; a dirty dressing protects at a fraction of its clean value and raises the risk of the wound becoming infected, and dirty or bloody clothing worn over an open wound pushes the same risk up. Carry spare clean dressings, swap them when they turn, and wash or replace the layer of clothing sitting over a healing wound.

Deep wounds are the wounds that punish improvisation. They bleed hard, they do not close with a bandage alone, and they frequently arrive with something still inside them. The full sequence is the treatment order above with nothing skipped: glass or debris out first (15 XP for a successful glass removal), disinfect, stitch (15 XP for the first stitch on that wound), clean bandage over the top.

Lacerations are different: they cannot be stitched. Their treatment is disinfection, a good dressing, and discipline about keeping that dressing clean while they close on their own.

Bullet wounds are rare in civilian play but follow the same logic one step further: remove the bullet (20 XP, the single best-paying First Aid action), then stitch, then bandage. Tweezers are the tool for both glass and bullets, which is why a pair belongs in every medical kit rather than in a base drawer.

A fracture — usually from a fall or a vehicle collision — is a mobility injury. Nothing is bleeding, but the limb will not bear weight, and the break will not close like a cut. The treatment is a splint, applied from the Health panel (15 XP for the first splint on that injury), followed by rest: a splinted fracture recovers far faster than an unsplinted one, and trying to fight or sprint on it just stretches the recovery out. Herbal support exists for the patient player: a comfrey poultice, made from foraged comfrey, is the traditional adjunct for fracture recovery — which means the medic and the forager are the same person more often than not (see the Foraging guide for medicinal plants and the Herbalist knowledge needed to identify them).

Burns share the scratch care loop — bandage and wait — with one extra step. When a burned part is flagged as needing cleaning, the panel offers Clean Burn: a timed action that consumes a suitable dressing, clears the flag and pays 10 XP, at the cost of some temporary pain (lower First Aid means more pain). Bandage with a sterilized dressing if you have one, disinfect when the wound is dirty, and replace dressings as they soil. Deliberately standing in a fire to farm that 10 XP is a trade every experienced player refuses: burns bring severe pain and a long recovery.

The word "infected" causes more wrong decisions in Project Zomboid than any zombie. There are two completely different things sharing it:

Ordinary wound infection is the state flagged on a body part in the Health panel. It is a bacterial-style complication of an untended wound: healing slows, pain rises, and it responds to exactly the care in this guide — disinfection, clean or sterilized dressings, antibiotics if it takes hold, and rest. It never turns anyone into a zombie.

The Knox virus is the zombie infection, and it never appears on the panel at all. It is rolled when a zombie wound is applied — 7% for scratches, 25% for lacerations, 100% for bites under default settings — and from that moment no vanilla treatment affects it. Disinfectant, antibiotics and clean bandages are still worth using on the wound itself; they are simply not a cure, and burning your rare medical supplies hunting for one is how a doomed character also becomes a badly supplied next character. If you are bitten on default settings, bandage the bleeding, stay mobile, and put your affairs — and your loot — in order.

One setting note, because it is widely misunderstood: under Everyone's Infected, bites still apply the virus; only Transmission set to None switches bite infection off entirely.

First Aid is trained by treating, full stop. The base XP awards (before skill books and trait multipliers) are fixed per action, and several of them are one-time per wound state — which is why the grind folklore about re-wrapping the same wound forever does not work.

Read the matching First Aid skill book before treating in bulk: Vol. 1 covers levels 1–2 at up to ×3; Vol. 2 covers levels 3–4 at ×5; Vol. 3 covers levels 5–6 at ×8; Vol. 4 covers levels 7–8 at ×12; Vol. 5 covers levels 9–10 at ×16. A volume does nothing outside its level band. Recorded medical VHS tapes (titles such as Combat Wound Management, Rosewood Medical First Aid and Emergency First Aid) also grant small amounts of First Aid XP when watched.

The honest training routes are unglamorous: treat every real injury completely instead of slapping on a rag; in multiplayer, be the person who treats everyone else — the doctor earns the XP for treatments on other players; and keep clean bandages stocked so the 5 XP bandage award is never wasted on a dirty wrap. What higher levels buy you is quality, not magic: shorter treatment times, better bandage durability, less pain added by procedures, better stitch quality, and more information on the Health panel — including those stitch-readiness cues above level 6.

A working kit is small. The point is that every item in it unlocks a step of the treatment order:

Stock it from pharmacies, clinics, hospital wings and ambulances, and restock dressings from any clothing you can rip. The kit lives in a dedicated bag or fanny pack so that it is on the patient — or on the medic — when it is needed, not in a crate at base.

No. The Knox roll happens when the wound is applied — about 7% for a scratch, 25% for a laceration, 100% for a bite on default settings. Disinfecting is still correct care for the wound itself and prevents ordinary wound infection, but it never re-rolls or removes the virus.

An Infected flag on the Health panel is an ordinary, treatable wound infection: slower healing, more pain, no zombification. The Knox virus is never shown on the panel and has no vanilla treatment. The two share a word and nothing else.

No. Only deep wounds take stitches. Lacerations are disinfected, dressed with a clean bandage, and kept clean while they close on their own.

Sterilize a clean Bandage or Rag with 0.1 L of Rubbing Alcohol, Vodka or Whiskey, or with a kept container holding 0.5 L of very hot water. The sterilized version has the same strength (4.0 for a bandage, 2.0 for a rag) and disinfects the wound when applied.

There is no loop that beats real treatment: read the current First Aid book, then treat injuries completely — glass removal and stitching pay 15 XP each, splints 15, burn cleaning 10, and the first clean bandage on a wound

5. In multiplayer, treating other players pays the doctor the same XP. Self-injury routines waste health and supplies for the same awards.

Yes. Once a stitched wound has had time to improve, remove the stitches from the Health panel. At First Aid above 6 the panel can show readiness cues; leaving stitches in indefinitely is not part of the treatment.