© 2014 The Royal Australian and New Zealand College of Psychiatrists. Objective: Clinicians dealing with referrals under the Mental Health Act in rural and remote parts of Australia face the difficult task of providing safe sedation whilst transferring the patient to an appropriate authorized facility. This paper reviews the efforts to overcome these challenges in the remote north-west of Australia. Methods: Senior medical staff undertook a review of sedation practice in the region. A search was made of the medical literature to determine whether evidence based treatment may exist elsewhere and this information was used in conjunction with consensus opinion to devise a new guideline. Results: Scant literature exists in the field of sedation and aeronautical evacuation of patients with acute mental health presentations in remote areas. Issues and challenges were identified and a new clinical guideline based on local expert consensus of good practice was developed. Conclusions: Standardizing the approach to managing agitated patients who are transferred under the Mental Health Act is essential in order to mitigate medical morbidity that may arise from sedation related complications. The sedation guideline developed by our service has been well received by staff, seems practical and feasible to implement and has the potential to reduce sedation related morbidity.