First point, this is an RNG heavy game. There's a certain amount of skill and planning but no guarantees of success. That said, I'm experiencing a high win rate (~50% on Medium, higher on Easy) on my games.

The most frequent deaths that I experience are:
1. Missing Darkness and running out of ammo or failing Lucky Shots at Darkness
2. Radiation damage (on Medium, thanks to greatly reduced Endurance on average)
Running out of health is unlikely, dying to venom or running out of time never happens (to me).

If one rolls a bad character, and attempting to win, it can be faster to reroll the character (incidentally also there's much less difference between an Easy run and a Hard run if you roll stats well- and if you get good items too they're nearly identical).

With that in mind, I recommend these items (on Easy you can select them straight away, on Medium you will need to roll high equip points and then choose to reveal. I recommend revealing over random item selection if you roll high):

C.A.T.S:
Attach it to the Laser Lance. +2 marksmanship and +1 lucky shot, you will need this to help prevent the most common death, losing to Darkness. With a marksmanship of 0 and this you will need to roll 9 instead of an unlikely 11, and your lucky shot odds are also considerably improved in your favour. You only get 3 shots max. when you face Darkness and we want to win, not draw.

Chainsaw:
+3 HtH, bypass nets and doors. I'm recommending this over getting a gun, although you can get both. You can bypass any door with this (although I would backtrack if you are near the beginning and passed a Dump and no terrible cards, as this will give you more Dumps).
The +3 HtH will help in every encounter, and will help if you get an average HtH of 9, or if your marksmanship/reflexes value is low.

If you intend to get a gun or a heavy weapon, I recommend the auto-rifle or the flamethrower(which can kill slimes). Both come with a high ammo capacity, decent kill rate and if you have both for some reason, take the extra clip on the flamethrower. Dynamite is a decent heavy weapons choice if your marksmanship is poor (use it to skip rooms, and it can be refilled).

Metal Detector:
Prevents mine damage, which is a common trap that deals a lot of Wounds, can destroy items and is difficult to dodge. Also gives you the best result possible on Razor Wire (outside of Wire Cutters) which is another common trap. As an added bonus, you can shoot Meat Machine (an enemy that can permanently steal stats) without taking a reflex roll.

Heat Detector:
Mainly to prevent the Lunatic from stealing something important (including any guns you have), it also assists in killing the Suicide Agent since you won't have to make a Reflex roll. The Suicide Agent deals a lot of Wounds and can destroy multiple items.

You get between 3-8 equip points and you only need 4 equip points to get you these items on Easy. 6 on Medium by revealing.

The main problems I can see would be getting Chasm without Climbing (which can be rectified with a Rope Launcher), and dying from Radiation (which can be rectified with 1 of the 3 rad items), so consider at least the first 2 items on the next list as alternatives.

If you have additional points, or don't favour one of the above items, then here are some more suggestions- although these tend to be subjective based on your stats and starting skill, as opposed to the above items:


1. Rad Fibre Suit or Radiation Pills/Geiger Counter (both can save your life if you rolled <19 Endurance, which can happen on Medium-Hard. The suit is the safer option as it should provide at least 3 Rad reduction overall if you need it, unless your Endurance is <12, in which case pills start to look attractive).

If you have really low Endurance, you have the option to take Radiation Pills, or the Geiger Counter. While the Geiger Counter can seem like a bad deal since you add cards from the discard pile, it makes you almost immune to Radiation damage, so you won't lose the game to it, thus it can potentially be a game decider either way.

If you're playing on Easy and don't have Climbing skill, consider the next item.

2. Rope Launcher (less useful if you have Climbing skill, but either way it allows you to skip cards when you get a Balcony which is a rare background. If you don't have Climbing, it allows you to skip Chasm, which is very important, and also makes it a potential Heat/Metal Detector replacement)

3. Steel Gloves/Torch (Steel gloves gives you +1 HtH in all situations. Torch gives you +1 HtH at night and another +1 vs Rats & Zombies. Steel gloves is generally the better option because you spend more time inside during the day and if your combat skill is low enough to require the Torch, you'll struggle against harder enemies during the day even more.)

4. Net Traps. I've quickly experimented with these. They won't work on Darkness, the Meat Machine or Slimes, and you only get 3 without a refill. However they're an automatic kill at the shoot phase against 3 Mutants(10-16 Combat) and/or Chaos Agents (The Martial Arts Assassin adds up to 14 Combat, inescapable and is hard to shoot like Meat Machine) for 1 equip point.

5. Auto-Rifle/Flamethrower/Dynamite. These can be considered luxury items given the cost, but they are still very cost-effective. Recommended for Slime(flamer only), Meat Machine(always), Mutants(high combat versions), Suicide Agent, and possibly Thief/KO Agents.

How to beat Hard mode?
The easiest way seems to be to use saves. You can't Reveal items at all, and your stats are generally even lower than on Medium, so having a good start would help considerably, even though that goes against the spirit of Hard mode.


What is Iron on the leaderboards)?
It's Hard without saving at all. There's no achievement for winning on Iron, and it's pure RNG for the most part (if you consider Hard with saving to be not pure RNG). Attempt this for fun :)