The HRSA-MCHC Emergency Medical Services for Children State (EMSC) Partnership Program is the longest running federally sponsored pediatric program in the country. The EMSC program is active in all fifty states, all five US Territories, the District of Columbia, and the three Compact of Free Association (COFA) countries. In 2010, American Samoa, Guam, CNMI, Republic of Palau, Republic of the Marshall Islands, Federated States of Micronesia, and Hawaii formed the Pacific Islands EMSC Region (PIER). This band of programs collaborates with each other’s program endeavors by associating technical resources, allying program partnerships/business associates, and working in concert toward education and training. This PIER presentation highlights this regions program developments and the launching of some very exciting initiatives, including telehealth.