Even amidst the devastation following the earthquake and tsunami in Japan that killed more than 20,000 people, it was the accident at the Fukushima Daiichi nuclear power plant that led the country's prime minister, Naoto Kan, to fear for "the very existence of the Japanese nation." While accidents that result in mass radiological releases have been rare throughout the operating histories of existing nuclear power plants, the growing number of plants worldwide increases the likelihood that such releases will occur again in the future. Nuclear power is an important source of energy in the U.S. and will be for the foreseeable future. Accidents far smaller in scale than the one in Fukushima could have major societal consequences. Given the extensive, ongoing Nuclear Regulatory Commission (NRC) and industry assessment of nuclear power plant safety and preparedness issues, the Center for Biosecurity of UPMC focused on offsite policies and plans intended to reduce radiation exposure to the public in the aftermath of an accident. This report provides an assessment of Japan's efforts at nuclear consequence management; identifies concerns with current U.S. policies and practices for "outside the fence" management of such an event in the U.S.; and makes recommendations for steps that can be taken to strengthen U.S. government, industry, and community response to large-scale accidents at nuclear power plants.