In the European Union (EU), the Directive 2013/35/EU has introduced the legal obligation of an ‘appropriate health surveillance’ (HS) for workers exposed to electromagnetic fields (EMF). Until now no agreement exists on the criteria, and on the contents, of such an HS. The EU Directive specifically refers to the protection from the risks associated with known direct biophysical and indirect short-term effects caused by EMF, while does not address to the suggested long-term effects since scientific evidence of a causal relationship is considered not adequate. Accordingly, at least in EU Countries specific objectives of HS are:
the prevention of established effect, such as the stimulation of muscles, nerves or sensory organs (including temporary annoyance or effects on cognition) and limb currents, or any thermal effects;
the health and safety of workers ‘at particular risk’, e.g. workers with active implanted medical devices (cardiac pacemakers, ICD, insulin pumps, etc.) or pregnant workers; nevertheless a comprehensive definition of the conditions inducing a ‘particular risk’, and of the safe thresholds, are still lacking.
It should be noted here that the exposure limits introduced by the Directive 2013/35/UE do not necessarily provide an adequate protection of such workers, e.g. interference problems with pacemakers may occur at lower levels. HS is therefore mainly aimed to evidence the occurrence of clinical symptoms possibly related to EMF and the existence of conditions possibly inducing particular risk, while specific laboratory test are not required, except on individual clinical basis. As a conclusion, at present time no agreement exists on the health surveillance of EMF exposed workers, and knowledge on some aspects, e.g. the conditions inducing particular risk and the possible thresholds, are still insufficient, and do not give an adequate support to the occupational physician to face the problem.
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