Exertional heat stroke is characterized by profound central nervous system dysfunction and core (rectal) temperature typically >
40°C. With prompt recognition and response probability of survival is excellent, however there are limited cases with Tc >
43.3°C associated with good outcomes. A 23-year-old male soldier was conducting land navigation training and was found unresponsive by non-medical cadre. Emergency medical services personnel obtained a rectal temperature of 44.3°C, which is the highest-ever body core temperature recorded in an EHS patient who survived without significant sequalae. In this case we report numerous key decisions that contributed to the good outcome. Among those were the use of a GPS-enabled tracking device that enabled location of the patient on the land navigation course, and rapid recognition and response by non-medical personnel at the point-of-injury. Additionally, prioritizing airway, breathing and circulation over choice of cooling modality was important in the setting of a patient in acute respiratory distress. Lastly, careful selection of pharmaceutical agents in the Emergency Department minimized additional stress, primarily the liver and kidneys, that were already significantly stressed. After transfer to a higher level of care due to developing heat-induced disseminated intravascular coagulation and liver failure, the patient was transferred to inpatient rehabilitation 3 weeks post-injury. He recovered by 14 months post-injury, has been medically cleared for return to active duty without limitations, and is continuing his military service.