The development of the new guidelines of the Italian association of medical radioprotection (AIRM) for the protection of the workers exposed to EMF related risks: new approaches and criteria

An up-to-date knowledge on the occupational risk related to electromagnetic fields (EMF) exposure and its prevention, and on the criteria and methods for an appropriate health surveillance (HS) of exposed workers are highly important, as: EMF are almost ubiquitous; in recent years, relevant changes and advancements in the technologies applied have been observed, e.g. the introduction of new equipment for Magnetic Resonance, involving potentially higher exposures for operators, and the development of the 5G technology, using also EMF bands with millimetric wavelengths, not often applied previously; in Italy the new Legislative Decree 159/2016 has been promulgated, implementing the Directive 2013/35/EU and, accordingly, introducing several substantial changes to the Legislative Decree 81/2008 on safety and health at work, in particular to its fourth chapter of the eight section ("Physical Agents"), entitled "The protection of workers from the risks related to electromagnetic fields exposure". For these reasons, the Italian Association of Medical Radioprotection (AIRM) has fully revised the "Guidelines for the health surveillance of workers exposed to non-ionizing radiation", published in 2012 together with the Italian Society of Occupational Medicine (SIML). Therefore, AIRM involved a multidisciplinary panel of experts, working in accordance to a rigorous scientific methodology, based on the recognized international indications for the development of guidelines (GL) in the medical field, as those proposed by the Guidelines International Network (GIN), the Grading of Recommendations Assessment, Development and Evaluation (GRADE), the National Institute for Health and Care Excellence (NICE) and the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Furthermore, the multidisciplinary panel conducted a systematic review of the scientific literature according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyzes" (PRISMA) criteria, aimed at answering to specific research questions, including the "PECO" (Populations of interest, Exposures, Comparators, and Outcomes) questions. The final stages of the GL include the revision of the GL-draft from an external group of independent experts, giving also an overall evaluation and opinions on the Recommendations elaborated, so that the panel group can elaborate a final document to be shared again, after agreement among all the experts, with a consensus reached by Delphi method in case of disagreement. The main GL objective is to guide occupational physicians in charge for the HS of EMF exposed workers, providing up-to-date indications on the contents and methods for an adequate HS of the workers, but also on the regulations and standards applicable, on the relevant occupational EMF exposure sources, on the possible adverse effects to be considered, including indications on the biological mechanisms involved, on the conditions of particular susceptibility to the EMF risk, on the criteria to be considered for the evaluation of "fitness to work" in case of occupational EMF exposure and finally also on the contents of adequate information and training for the workers exposed. As a final objective, the AIRM GL on HS of workers exposed to EMF will be proposed for public consultation to the Italian National Guidelines System, as required according to the Law n. 24/2017, also known as the «Gelli law».