Forgive me if this question isn't exactly "on topic" for this site -- it's a bit meta.
I am an academic in the UK, and I occasionally design electrical devices that plug into "the mains" in one guise or another. Some of these are (novel) medical devices. We have an internal blinded peer-review process for this, wherein designs that I produce are reviewed informally, and then formally, for electrical safety prior to manufacturing taking place. I find this invaluable: it isn't my job to know a lot about the wiring regulations and can focus on the science I am interested in (which inevitably isn't at 230 VAC).
It is an internal requirement that anything I use on a patient is designed as if it were for sale in the EU, and we meet appropriate standards accordingly. Note that this is pretty common: there are strict limitations on what work one can do on your house without being a qualified electrician, for example, and it's generally a legal requirement that a 'competent person' sign off on anything involving electricity.
Many of the rules I have been asked to follow surprise me in their depth of thought. For example, above a certain current limit, ventilation hole sizes are further reduced on a device to prevent a dropped-in screwdriver welding contacts together. The order of washers and contacts (star, then spring, then contact, then spring, then nut) is specified for binding protective earthing bolts to metal casework panels. Fuses are specified on the incoming live side only, and not neutral (and, in fact The Electricity Safety, Quality and Continuity Regulations state that, as of 31st January 2013, fused neutrals shall not be retained. There is an HSE requirement for fused neutrals cut-outs to be removed within 28 days of being identified.). I could go on.
Occasionally, we will buy something from elsewhere in the world (e.g. the US, China) sold for an international audience, and this committee will declare it electrically substandard, and mandate remedies. Typically these faults relate either to earthing resistance, conductor-to-earth insulation (i.e. it fails a meggar test) or power supply leakage currents. Often our internal standards seem to go beyond those required internationally -- e.g. IEC 60601 vs BS60601.
However, I've noticed that this level of "paranoia" seems to not be the case elsewhere. In particular, DIY stackexchange has examples of wiring that I would naïvely consider to be almost criminal, often with commentators agreeing. What I call RCDs (common on every socket in the country) are only required to be used in the US in "high risk" areas -- e.g. in the bathroom (where no UK house has a conventional 13 A socket at all). I haven't even mentioned how the Type G plug is wonderfully over-engineered, and the average device has two fuses (typically one lower, slow-blow, one higher current and faster one), not one.
[Edit: Some quick examples of what I'm talking about would be:
- A child sticking scissors into a socket (not possible with a type G plug -- and they didn't trigger an appropriate CB quickly enough)
- An unbonded neutral without other fault (not possible with multiple PEN house wiring, specifically designed against otherwise)
- A fault with current conducing to ground through plumbing, also likely to stopped with an RCD/GFCI]
My question is this: is the UK's paranoia justified? Do we have anything to show for it? Is the rate at which electrical safety incidents occur higher in the United States compared to the UK? Or does the magic difference between 110 VRMS and 230 VRMS obliterate any potential safety gain that this vast amount of work would achieve?