Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Burn Injuries

How prevalent are burn injuries?

Burns are one of the most common household injuries. It is estimated that about 1.25 million burn injuries occur each year in the United States. Due to burn prevention and education programs, this rate has actually dropped by 50% in the last 30 years. Also, because of the advances in treatment of burns an individual is now much more likely to survive a serious burn injury. Since more individuals are surviving even the most severe of burn injuries, especially those burned as children, there are more burn survivors in the workplace (American Burn Association, 2000).

What causes burn injuries and how are they classified?

Burns are usually caused by heat (thermal burns), such as fire, or hot liquids. Burns can also be caused by chemicals and radiation such as sun light and electricity (Merck, 2003).

Burns are classified in three ways: first, second and third degree:

First degree burns are the most common type of burn injury. This involves only the top layer of skin and is characterized by pain, redness, and swelling. Sunburn is a typical first degree burn (Merck, 2003).

Second degree burns involve the first and second layer of skin. They are characterized by blistering of the skin, redness, and swelling and are very painful (Merck, 2003).

Third degree burns are the most severe and often result in extensive scarring. They can require a long recovery time and may result in severe limitations (Merck, 2003).

Burn Injuries and the Americans with Disabilities Act

Is a burn injury a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with burn injuries will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with Burn Injuries

(Note: People with burn injuries may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with burn injuries will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with a burn injury experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with a burn injury been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with a burn injury to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding burn injuries?

Accommodation Ideas:

Gross Motor Impairment:

Modify the work-site to make it accessible
Provide parking close to the work-site
Provide an accessible entrance
Install automatic door openers
Provide an accessible restroom and break room
Provide an accessible route of travel to other work areas used by the employee
Modify the workstation to make it accessible
Adjust desk height if wheelchair or scooter is used
Make sure materials and equipment are within reach range
Move workstation close to other work areas, office equipment, and break rooms
Provide material lifts
Provide stand/lean stools
Provide anti-fatigue matting

Fine Motor Impairment:

Implement ergonomic workstation design
Provide alternative computer access
Provide alternative telephone access
Provide arm supports
Provide writing and grip aids
Provide a page turner and a book holder
Provide a note taker
Provide ant vibration gloves
Provide tool balancers

Heat Sensitivity:

Reduce work-site temperature
Use cool vest or other cooling clothing
Use fan/air-conditioner at the workstation
Allow flexible scheduling and flexible use of leave time
Allow work from home during hot weather

Cold Sensitivity:

Increase work-site temperature
Use portable space heaters
Dress in layers using thermal material or fleece
Wearing gloves
Provide heated clothing
Allow work from home during cold weather

Working Effectively with Supervisors:

Provide positive praise and reinforcement
Provide written job instructions
Develop written work agreements that include the agreed upon accommodations
Communicate performance standards and the consequences of not them
Allow for open communication to managers and supervisors
Establish written long term and short term goals
Develop strategies to deal with problems before they arise
Develop a procedure to evaluate the effectiveness of the accommodation

Interacting with Coworkers:

Educate all employees on their rights to accommodations
Provide sensitivity training to coworkers and supervisors
Do not mandate that employees attend work-related social functions
Encourage all employees to move non-work related conversations out of work areas

Difficulty Handling Stress and Emotions:

Provide praise and positive reinforcement
Refer to counseling and employee assistance programs
Allow telephone calls during work hours to doctors and others for needed support
Allow the presence of a support animal
Allow the employee to take breaks as needed

Sleep Disorder:

Allow flexible work hours
Allow frequent breaks
Allow work from home

Situations and Solutions:

A drafting engineer has third degree burns to 80% of his body. He is limited in sitting for extended periods. JAN provided him information on sit/stand work stations.

A school teacher with burn injuries to both hands was having trouble writing, particularly when she has to reach overhead to write on the chalkboard. JAN provided information on assistive writing aids such as pen/pencil grips and devices to make holding a pen/pencil easier. A desktop tablet that projected onto a screen in front of the classroom allowed her to do traditional board writing using a pen/tablet computer system.

A person employed as a ground maintenance laborer was recovering from severe burns of his head, neck, and back. His job required him to work outside during most of the day. Due to the scars he was unable to sweat to cool his body temperature and he was concerned about getting sunburned. His employer provided him with a hat, long sleeved light cotton shirts and a cool vest. He was given a portable beach umbrella to provide him shade and he was encouraged to take breaks as often as he needed them. The employer also changed his schedule to an earlier start time so that he could work mainly during the morning hours.

A consultant employed by a federal agency has severe limitations in fine motor movements as a result of burns to her hands. She has difficulty writing and typing. Her job requires her to use a computer to enter data and maintain files. An articulating keyboard tray was added to her desk, allowing her to bring the keyboard closer to her body. She was also given a split keyboard and a trackball mouse that allows her to use her fingers to move the curser and type, eliminating the need for her to use her thumbs. The individual combined these devices with speech recognition.

Resources

References

American Burn Association. (2000). Burn incidence and treatment in the US: 2000 fact sheet. Retrieved December 21, 2005, from http://www.ameriburn.org/pub/BurnIncidenceFactSheet.htm

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Merck & Co, Inc. (2003). Burns. In The Merck manual home edition: Online medical library (1st ed., sec. 24, chap. 289). Retrieved December 21, 2005, from http://www.merck.com/mmhe/sec24/ch289/ch289a.html#sb289_1