Recent experience with H5N1 avian influenza virus in Asia has highlighted   concerns of a novel influenza strain capable of spreading easily and causing serious illness in humans, which would cause an influx of patients into hospitals. Los Angeles County Department of Health Services (LACDHS) surveyed hospitals in order to determine their level of preparedness for pandemic flu. Surveys were electronically mailed in July 2005 and November 2005 to infection control professionals from 103 acute care hospitals (74 with emergency departments). A copy of the LAC Hospital Preparedness Influenza Plan (HPIP) was sent with the survey in November. Questions included information on availability of personal protective equipment, antiviral medication stockpile, and HPIP. Responses were faxed back to LACDHS and entered into an Access database. The final response rate was 69.9% (72/103). Forty-five hospitals (62.5%) had extra N-95 masks, and 46 (63.9%) had additional isolation gowns in the event of pandemic flu. Forty (59.7%) hospitals stocked influenza antiviral medication every flu season, 19 (28.4%) stockpiled on an on-demand basis, and eight (11.9%) replied “other.” Of the hospitals that stockpiled, 61 (92.4%) stockpiled amantadine. Twenty-four (33.3%) hospitals had a HPIP, with hospitals with EDs more likely to have a plan (χ² = 0.0080). Hospital preparation varied widely across LAC. Most hospitals did stockpile a common influenza antiviral medication, but only one-third responded that they had a HPIP. Preparation is one of the first lines of defense against pandemic flu. Direction, education, and consistent follow-up is important to ensure hospital preparedness and implementation.