In 2007, the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) contracted with the Center for Biosecurity of the University of Pittsburgh Medical Center (Center) to conduct a two-year, comprehensive assessment of hospital preparedness in the U.S. from the time of the establishment of the Hospital Preparedness Program (HPP) in 2002 through mid-2007 and to develop tools and recommendations for evaluating and improving future hospital preparedness efforts. Hospitals Rising to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program and Priorities Going Forward is the second major deliverable for the project. It includes our assessment of the impact of the HPP on hospital preparedness from 2002 through 2007 and our preliminary recommendations for improving the state of U.S. hospital disaster preparedness.