Each MCA is required to establish written protocols as defined in Section 20919 of the Public Health Code.  Protocols adopted by the MCA and approved by the department have the force and effect of law.  Licensed life support agencies and individuals are accountable to the MCA in the provision of emergency medical services as defined in protocols.  Each participating and non-participating hospital within a MCA region shall follow all standards, policies, procedures, and protocols established by the MCA as approved by the Department.