Mountaineering is a dangerous recreational activity with falls causing severe injuries and deaths. Survival from falls longer than 100 m is uncommon. We present a case of a high-altitude porter on Mount Everest who fell 400 m and survived. He slipped from a ridge at 7000 m (22,900 ft). A rescue party found him above Camp 2 (6600 m, 21,600 ft) and arranged a helicopter rescue. The Everest ER medical team at Everest Base Camp (5400 m, 17,700 ft) received the climber. They identified a head injury without signs of other serious trauma. A doctor provided manual inline stabilization of the cervical spine, airway support, and ventilation for the patient during the helicopter and ground transport to a tertiary hospital in Kathmandu. The time from the fall to definitive hospital care was 2.5 h. The hospital emergency team diagnosed an epidural hematoma and subarachnoid hemorrhage without midline shift and right parietal, orbital, and maxillary fractures. The neurosurgical team evacuated the intracranial bleed. The patient spent 6 d in the hospital. He had a positive neurological outcome. He had mild cognitive impairment and vision loss in his left eye but could perform activities of daily living. He returned to physical work, but not to climbing. This case report provides evidence that survival is possible after falls from extreme heights and sheds light on the challenges of an evacuation from austere environments.