Accommodation and Compliance Series:
Employees with Burn Injuries
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://AskJAN.org/soar.
How prevalent are burn injuries?
Burns are one of the most common household injuries. It is estimated that about 450,000 people per year have burn injuries that require medical treatment (American Burn Association, 2013). Burns result in about two million physician visits per year (National Library of Medicine, 2014). Because of the advances in treatment of burns, an individual is now much more likely to survive a serious burn injury and continue to be a productive employee.
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 sunlight, gas, and electricity (Merck, 2014).
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, 2014).
- 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, 2014).
- 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, 2014).
Are burn injuries 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 Regulations . . ., 2011). 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 an impairment (EEOC Regulations . . . , 2011). For more information about how to determine whether a person has a disability under the ADA, visit http://AskJAN.org/corner/vol05iss04.htm.
(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:
- What limitations is the employee with a burn injury experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Has the employee with a burn injury been consulted regarding possible accommodations?
- 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?
- Do supervisory personnel and employees need training regarding burn injuries?
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 anti-vibration gloves
- Provide tool balancers
- 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
- 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 meeting 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
- Allow flexible work hours
- Allow frequent breaks
- Allow work from home
- Implement ergonomic workstation design, e.g., ergonomic chair and adjustable workstation to alternate between sitting and standing
- Reduce repetitive tasks or interrupt the tasks with other duties
- Provide carts and lifting aids
- Allow flexible work hours
- Allow frequent breaks
- Allow work from home
- Reserve a rest area with cot for breaks
- Pre-notification of construction, painting, pesticide use, and heavy cleaning
- Use non-toxic carpeting or alternative floor covering such as tile or cotton throw rugs
- Use non-toxic building materials and lawn products
- Allow use of oxygen
Situations and Solutions:
A drafting engineer had third degree burns to 80% of his body. He was limited in sitting for extended periods. He was accommodated with an ergonomic workstation, including a sit/stand work station.
A school teacher with burn injuries to both hands was having trouble writing. JAN provided information on assistive writing aids such as pen/pencil/marker grips and devices to make holding a pen/pencil/marker easier.
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. The employer also changed his schedule to an earlier start time so that he could work mainly during the morning hours during extreme heat.
A consultant employed by a federal agency had severe limitations in fine motor movements as a result of burns to her hands. She had difficulty typing for long periods of time. 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 allowed her to use her fingers to move the cursor and type, eliminating the need for her to use her thumbs. The individual combined these devices with speech recognition.
A security guard with breast cancer was burned from radiation treatment. She had difficulty wearing the polyester uniform with embroidered insignia that was required by company policy. The employer modified the dress code policy by having a uniform made of cotton material with the logo and employee name added with a no-sew iron-on adhesive.
There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.
American Burn Association. (2013). Burn incidence and treatment in the United States: 2013 fact sheet. Retrieved December 4, 2014, from http://www.ameriburn.org
EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).
Merck & Co., Inc. (2014). Burns. In The Merck manual home edition: Online medical library. Retrieved December 4, 2014, from http://www.merckmanuals.com
National Library of Medicine (2014). Burns: Interactive health tutorial. Retrieved December 4, 2014, from http://www.nlm.nih.gov