The Doom Track is a section of the Ancient One's card that acts as both a timer counting down to its awakening and a health meter for the Final Battle. One token is placed on the track every time a new Gate opens, as well as during certain encounters. Tokens can be removed from the track only rarely, most often by using the Elder Sign item. When a token has been placed on every space in the track, the Ancient One Awakens and the final battle begins.
During the final battle, the Doom Track acts as the measure of the Ancient One's health. When the Investigators attack, one token is removed every time they roll a number of successes equal to the number of investigators in the game. This count is cumulative - in a five-person game, two successes on one roll and three in another adds up to remove one token from the track. If the last token is removed from the track, the Ancient One is defeated and the investigators have achieved Victory.