From the publisher’s rulebook
Who goes first in Cthulhu Realms?
Tasty Minstrel Games English rules, 2015

The player who most recently went insane is the Start Player and takes the first turn.
Rule details
Play then proceeds clockwise.
For the opening hand, the Start Player draws three cards; other players draw five.
Source & edition
- Cthulhu Realms: English rulesTasty Minstrel Games / White Wizard Games · Gameplay, opening paragraph · Checked 2026-09-24
Image: © Tasty Minstrel Games and credited artists · Moth Meeple 2017 unboxing of Tasty Minstrel Games 2015 edition
If your rules call for a random choice, use the player picker.
If there’s a tie
The rulebook doesn’t say. If you need a tie-break, pick a player at random.
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