Our Referral Process

We pride our centers on the ease of access for patient referring facilities, agencies and physicians. By calling (855) 863-9595 or (706) 830-7511, you reach one of our physicians or mid-level practitioners who will assist in determining the urgency of the patient’s injury. We will also assist with patient transfer to one of our burn centers. For those requiring less immediate treatment, an appointment at one of our outpatient facilities will be scheduled.

Burn Transfer Form
Hyperbaric Oxygen Therapy
Laser Scar Therapy
Outpatient Clinic
Reconstructive Surgery
Skin & Soft Tissue Disorders
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The premise and promise of the burn center has been to never turn away a patient in need of specialized burn care. BRCT is unique in many ways, including treating both children and adults to the comprehensive circle of care offered by our medical professionals.

At BRCT, the treatment of patients goes beyond their physical burns and wounds. From the expertise of critical care and pediatric intensivists to the consultation of staff psychiatrists, we truly treat the entire patient. We understand that even a small burn can be catastrophic to entire families, and we work hard to lessen the lasting impact of such injuries.

The acute care is often followed by reconstruction as burn scars can be restricting and interfere with a patients lifestyle. This is often a long process requiring years of reconstructive procedures. Therefore, we have a great opportunity to know our patients and connect with them on a level unlike many other specialties.

Many burn centers focus on the acute injury and once the patient is healed refer them to other surgeons to perform their reconstruction. It has been our experience that having the intimate knowledge of what the patient went through in the initial stages helps us to optimize their reconstructive efforts.


Most burns occur at home or work, and the proper response is important both to helping the patient and ensuring proper treatment of the injury.

First, stop the burning process by removing the source of the burn. However, do not endanger yourself. For example, do not try to grab a live electrical wire.

The next step is to remove any jewelry or clothing around the burned area. This will help prevent further damage if swelling occurs. If clothing is stuck to the burn site, do not peel it off. Instead, contact emergency services immediately.

For initial treatment of minor burns, run cool tap water over the burn for at least 20 minutes. For more severe burns, seek medical treatment immediately.

Do not apply butter, grease, honey or powder
Do not use cotton balls or wool to clean a burn
Do not apply ice directly to the burn

Cover the burn with a dry, sterile cloth
Use ibuprofen for pain management


First Degree
Red and painful with no blistering of skin, such as a minor sunburn

Second Degree
Red and painful with blistering – sometimes significantly blistering – of skin. Injuries will maintain a wet appearance.

Third Degree
Injuries have charred appearance, and will be dry to touch. They will have a leathery or white appearance, and be insensate. Treatment of injury will require skin grafting.

Fourth Degree
Injuries will be catastrophic, involve muscle, tendon and bone, and most often require amputation as treatment.

Transfer criteria recommended by the American Burn Association:

  • Partial thickness burn greater than or equal to 10% TBSA
  • Any burn involving the face, hands, feet, genitalia or major joint
  • Any third degree burn
  • Chemical burn injury
  • Electrical burn injury
  • Inhalation injury
  • Burn injury in patients with pre-existing medical disorders
  • Burns involving concomitant trauma in which the burn injury poses the greater risk
  • Burned children in hospitals without qualified personnel or equipment for the care of children
  • Burn injury in patients who will require special social, emotional, or long-term rehab

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The specialty of burn care is not relegated to chemical, electrical, flame and scald injuries. At BRCT, our team of board-certified surgeons and plastic/reconstruction specialists are also trained in the most advanced treatment and management of cold injuries including thrombolytic therapy.

  • Cold injuries can result in temporary or permanent tissue damage caused by prolonged exposure to temperatures less than 23°F.  Injuries can range from frostnip to more complex injuries including significant local tissue loss and/or limb amputations. The classification of frostbite injuries is similar to burn injuries:
    • First Degree: Superficial without blister formation; Frostnip
    • Second Degree:  Light colored blisters with subsequent peeling
    • Third Degree:  Dark blisters that evolve into thick, black eschar
    • Fourth Degree: Involves bone, tendon and/or muscle
  • A better understanding of the pathophysiology of the disease process has led to recent advancements in the treatment of frostbite.  No longer considered to be a condition of simple tissue freezing, cold injuries are now recognized to be a more complex ailment associated with local tissue injury and vascular occlusion.   Today, treatments are designed to rewarm the affected tissues rapidly, while improving blood flow to the injured area with thrombolytics.  Tissue plasminogen activator, commonly known as tPA and given to stroke victims, is a proven, effective treatment for frostbite injuries resulting in significantly lower amputation rates.  Patients presenting with frostbite should be viewed as a vascular emergency and immediately be referred to a burn specialist who is trained in the use of tPA.  Rapid diagnosis and treatment of cold injuries can significantly reduce the morbidity associated with this injury.
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Hyperbaric Oxygen Therapy
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Hyperbaric Oxygen Therapy (“HBO Therapy”) allows more oxygen to pass throughout your body to promote healing, fight infection and kill bacteria.

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Laser Scar Therapy
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Laser scar revisions can assist with loosening of scars to improve range of motion, decrease itching and pain from scars and offer an improved appearance of the scarred area.

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Outpatient Clinic
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We provide coordinated care with a team of skilled and experienced professionals that includes surgeons, certified wound specialists, nurses, physical & occupational therapists, nutrition counselors and social services coordinators.

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Reconstructive Surgery
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One of the most important steps in the healing of a catastrophically burned patient is the process of reconstruction, especially of extensively burned areas. Due to scar formation from deep second or third degree burns, patients will likely need reconstruction to improve restrictive and hypertrophic burn scars. These burn scars to the face, neck, hands and other regions of the body can restrict motion, such as chewing, drinking and hand or neck or leg movements.

Our team of board-certified plastic and reconstructive surgeons at BRCT, is continuing to develop different avenues to best treat our patients, those with congenital and acquired skin anomalies, wounds and people interested in generally improving their appearance and/or self-esteem. Through our experience of working with thousands of patients, we have developed the skills necessary to create a thorough treatment plan to improve the aesthetics, form and function of our burn patients. We are not only involved in the reconstruction process, but also in the in the acute phase of patient care. This helps plan procedures for future reconstruction, enhance rehabilitation and overall improve patients’ form, function, aesthetic outcome and, ultimately, their quality of life.

Our plastic and reconstructive surgeons use their knowledge and experience of dermal substitutes, skin grafting, tissue expansion, laser therapy, flap reconstruction and microsurgery to help rehabilitate burned victims.

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Skin & Soft Tissue Disorders
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Burn and reconstructive surgery is not the only service provided by our surgeons at BRCT. Our team of board-certified surgeons and plastic/reconstruction specialists are trained in the treatment and management of skin and soft tissue disorders, including:

  1. Degenerative skin disorders: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN)
  2. Infectious processes: Cellulitis and Necrotizing Fasciitis
  3. Complex wounds associated with chronic diseases: Diabetic Foot Ulcers and Calciphylaxis
  • Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are degenerative skin disorders differentiated by percentage of involved body surface area.  While there is some overlap in categorization of SJS and TEN, TEN is characterized with involvement greater than 30% of total body surface area.  Patients often present with a patchy reddening or detachment of the top layer of skin following exposure to a “trigger,” most commonly a medication.  The disease process affects all epithelial tissues of the body and is associated with a significant inflammatory response.   The combination of epithelial loss and severe inflammation leaves the patient susceptible to infections and multi-organ system failure.  The care and treatment for these individuals is similar to those with a thermal injury.  It is for this reason why the medical community favors treatment of these individuals at a multi-disciplinary burn center to limit morbidity and mortality.
  • Necrotizing fasciitis (NF) is a bacterial infection of the skin, commonly occurring when bacteria pass into the body through an open cut, scrape, burn wound or other puncture wound. Patients with NF may complain of swelling and muscle soreness at the site of the infectious process.  The skin is generally warm to the touch and red or purple in color.  As the disease progresses, it may be accompanied by blisters, ulcers or blackening of the skin.  NF is a medical emergency and should be treated in an urgent manner as the bacteria quickly spreads through connective tissue, and can lead to amputations or death within a narrow window of time.  Aggressive surgical debridement, coupled with systemic antimicrobials and hyperbaric oxygen, is often required to prevent the infection from continuing to spread and potentially result in significant morbidity and mortality.
  • Diabetic ulcers occur in approximately 15% of diabetic patients.  If treated properly, patients can avoid amputation, which affects about 1 in 5 patients who develop an ulcer.  Patients who develop ulcers should seek immediate attention from a specialist.
  • Cellulitis is a bacterial skin infection that can spread rapidly if not treated immediately.  Cellulitis can result in necrotizing fasciitis or sepsis, potentially life threatening conditions.  Patients often present with painful, swollen areas of red skin that are warm to the touch.  Although it’s most commonly seen on the skin of the lower legs, it can occur anywhere throughout the body.  Untreated or mistreated cellulitis can extend through the soft tissues into the lymph nodes and bloodstream, resulting in life threating conditions.  Cellulitis should be treated aggressively with antimicrobials while excluding the diagnosis of necrotizing fasciitis and sepsis.  Significant cellulitis can result in morbidity and mortality and thus should be treated by infectious experts at a medical facility or burn center.
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John Hershman, MD
Medical Director
John Hershman, MD
Medical Director


  • M.D., University of Texas Medical Branch, Galveston, TX, 2004-2008
  • B.S., Biomedical Science, Texas A&M University, College Station, TX, 2000-2004


  • Plastic Surgery, Georgia Regents University, Augusta, GA, 2013-2016
  • General Surgery, Medical College of Georgia, Augusta, GA, 2008-2013


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  • Partnered with Level I Trauma Center
  • Dedicated Burn Critical Care Unit
  • Laser Scar Therapies
  • Thrombolytic Protocol for Frostbite
  • Education Seminars available upon request
  • Dedicated Burn O.R.
  • 24/7 Coverage of Board-certified Physicians
  • Access to Hyperbaric Oxygen Chambers
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Immediate Emergency Burn Care
  1. Treat according to BLS or Protocol
  2. Use airway and C-Spine precautions.
  3. Stop the burning process.
First Aid for the three major categories


  • Stop the burning process with water
  • Remove all clothing and jewelry
  • Monitor pulses in circumferentially burned extremity
  • Keep patient warm to avoid hypothermia


  • BE SAFE: Turn off power source or remove source before rescue
  • Monitor for cardiac arrhythmias
  • Start CPR if needed
  • Remove clothing/shoes/jewelry
  • Document pulses of affected extremities
  • Keep patient warm to avoid hypothermia


  • Remove all clothing/shoes/jewelry (these can trap chemicals)
  • Flush for one hour at the scene if no other trauma and the patient’s vital signs are stable
  • Brush powder off before flushing with water; flush with copious amounts of water by shower or hose for an additional hour at the local emergency room
  • Keep patient warm to avoid hypothermia
Airway Management
  1. Administer high flow 100% oxygen to all burn patients. Be prepared to suction and support ventilation as necessary.
  2. If you suspect an inhalation injury, consider intubation. An inhalation injury may be present if you observe the following:
    • Burned in an enclosed space
    • Dark or reddened oral and/or nasal mucosa
    • Burns to the face, lips, nares, singed eyebrows, singed nasal hairs
    • Carbon or soot on teeth, tongue, or oral pharynx
    • Raspy, hoarse voice or cough
    • Stridor or inability to clear secretions may indicate impending airway occlusion
Patient History

Obtain the following patient information:

  • How was the patient burned?
  • Rule out associated trauma
  • Medical history
  • Current medications
  • Allergies
  • Last meal
  • Drug and/or alcohol history

Provide Tetanus Toxoid prophylaxis as indicated.


Give all pain medication via IV. Provide Morphine Sulfate (if not contraindicated) in the following proportions:

  • Adults: 3-5 mg IV q 10 minutes or prn
  • Children: titrate IV Morphine Sulfate by weight (0.1 mg/Kg/dose) or consult Burn Center surgeon
  • Do not use ice or iced normal saline as a comfort measure


Place Ng tube and decompress stomach if nausea and vomiting are present, if patient is intubated or TBSA greater than 20%. Keep patient NPO.

Circumferential Burns

Consult a Burn Center surgeon concerning circumferential burns of the extremities or thorax. An indicator of decreased blood flow due to circumferential burns is slowing of capillary refill or diminished pulses. Palpate pulses. If not palpable, then use a Doppler ultrasound device. If unable to discern pulses, consult a Burn Center surgeon.

Deep circumferential burns of the chest may impair or prevent mechanical ventilation of the burn victim. Escharotomies are rare but occasionally necessary at the referring facility. Consult a Burn Center surgeon.


  • Wrap patient in clean or sterile dry sheet
  • Place blankets over patient to ensure warmth
  • Cover head with extra layer
  • Warm fluids if possible
Hallmarks of child abuse


  • Unexplained burn
  • Implausible history
  • Inconsistent history
  • Delay in seeking medical care
  • Frequent injuries, illnesses
  • Child accuses an adult
  • One parent accuses the other
  • Alleged self-inflicted
  • Alleged sibling-inflicted
  • Pattern of burn
  • Immersion burns
  • Rigid contact burns
  • Other signs of abuse/neglect
  • Prior Child Protective Services involvement

If child abuse/neglect is suspected, please contact the local Child Protective Services Office as soon as possible.

Fluid Resuscitation

Calculate Fluids: Parkland Formula

Adults: Ringer lactate: 4ml x weight in kg x %TBSA burn. Give first half of fluids over first 8 hours. Give remaining fluid over next 16 hours. Children over 10 years old: use same formula as above

Children Under 10 Years Old: Use the same formula with addition of maintenance fluid of D5W to maintain glucose levels. Consult Burn Center Surgeon

Consider High Dose Vitamin C Therapy for TBSA > 30%. Call the Burn Center at (855) 863-9595

Estimate depth of burn injury


1st Degree (Superficial Partial Thickness)
Reddened, painful warm to touch; no blisters or skin sloughing, e.g. sunburn

2nd Degree (Partial Thickness)
Reddened, blistered, painful to touch, blanches to touch; when blister derided, weeps fluid from wound. Regularly re-assess second degree burns to ensure the injury had not converted to third degree.

3rd Degree (Full Thickness)
Black, brown, white, or leathery wound, firm in appearance; does not blanch and is not painful to touch

4th Degree (Full Thickness)
Charred appearance; burns that extend below the dermis and subcutaneous fat into the muscle bone or tendon

ABA Criteria for referral

The American Burn Association has identified the following injuries as requiring referral to a burn center after initial assessment and treatment:

  1. Partial thickness burns greater than 10% total body surface area (TBSA)
  2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints
  3. Any third-degree burn
  4. Electrical burns, including lightning injury
  5. Chemical burns
  6. Inhalation injury
  7. Burn injury in patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality
  8. Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if trauma poses the greater immediate risk, the patient should be initially stabilized in a trauma center before being transferred to a burn center. Physician judgement will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols
  9. Burned children in hospitals without qualified personnel or equipment for the care of children
  10. Burn injury in patients who will require special social, emotional or long-term rehabilitation

For questions regarding a burn injury, regardless of size, please call (855) 863-9595

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If it’s an emergent transport, use a moist, saline dressing.If you’re sending a patient to follow-up in our clinic in the next 24-48 hours, use a polysporn, xeroform, dry-sterile dressing.


The indications for intubation do not differ from those for a trauma patient


No. The majority of early burn wounds can be treated with topical, antimicrobial agents because the risk of early burn wound infection is low.  The goal is to prevent early colonization.


The anatomy of a child places them at greater risk for airway obstruction following a thermal injury. A child’s airway is relatively small, thus less swelling is needed to cause a clinically significant airway obstruction. Practitioners or caregivers should be aware of these anatomical differences and the potential risk for airway compromise. Soot about the nose and mouth, carbonaceous sputum, and facial involvement following a thermal injury should alert the physician or caregivers to potential future airway issues.  The decision to intubate is based on good clinical judgement with the goal of securing an airway being an elective event versus emergent one.

  1. Notify Child Protective Services/Department of Child and Family Services
  2. Notify Law Enforcement
  3. Rule out other significant injuries (Head CT, Skeletal Survey if able)
  4. Document other injuries/findings
  5. Document history provided by care givers using exact quotes when able

Burn and Reconstructive Centers of Texas is dedicated to providing comprehensive burn and wound treatment to patients Prior to their arrival at our facility. This continuum of care for patients of all ages - from initial injury through reconstruction - can continue through their entire lifetime.

It is our approach, knowledge and expertise that sets us apart from other burn care practices. We are committed to providing prompt acute burn care to patients, which is evident in the 24-7 availability of a dedicated burn operating room. This removes the need for our patients to "compete" for operating room space and helps decrease the risk of infection and other complications associated with delayed excision.

It is significant that we treat patients of all ages under one roof. Why? If an entire family - or even more than one family member - is involved in a burn incident, they are treated at the same facility, which helps decrease the stress on the family and offers a central location for supporters to gather. For our youngest burn patients, we utilize pediatric burn intensivists to improve their chances of survival and minimize complications.

Our training also sets us apart. Our surgeons practice the latest and most-effective burn treatment techniques to help ensure quality outcomes for the initial acute treatment of burn injuries. For long-term reconstructive care, our surgeons have also received advanced training in plastic reconstruction, which allows for early inclusion of reconstruction practices to ensure optimal function and possibly avoid future reconstruction of the restrictive scars. We bolster this training with the 24/7 direct connection to the expertise of the staff at the Joseph M. Still Burn Center in Augusta, GA, the nation's largest and most experienced burn center. Their knowledge base cannot be duplicated anywhere else in the United States. We also have a strong educational connection with the JMS Research Foundation, which focuses solely on treatments to improve the outcome of burn victims, while providing early institution of revolutionizing therapies.

Through our vast experience with burn and wound care, we have also developed an expertise in skin disorders including Stevens-Johnson Syndrome, necrotizing fasciitis, and others.


The BRCA Foundation is a 501(c)3 organization dedicated improving patient care, supporting patients and families after they have been discharged from one of our centers, and facilitating education about burn, wound and hand care throughout various medical communities.

Mission Statement
The healing and helping of patients goes far beyond the walls of our burn centers. The BRCA Foundation is committed to helping patients and their families, while continuously working to improve care throughout the world.

Our foundation was founded on three guiding principles:

  • Patient Support
  • Education & Scholarship
  • Community Outreach

To learn more about us or find out how you can help support our mission, please email: [email protected]

All donations to the BRCA Foundation are tax deductible.

BRCA Foundation
P.O. Box 3726
Augusta, Georgia 30914