Fight club mechanics in free roam

Basically, as the title says, to have the fight club mechanics outside of the side missions would be dope. However, I'm more particularly interested in the knockout mechanic. Like how, the lower your health is the longer your character stays knocked down. I think It would make the game more challenging/realistic.
Also, I have no knowledge of modding, so I'm not sure if this is even possible.
 
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