Saint-Pierre-et-Miquelon is a French overseas territory in North America, with a population of 6,008 in 2016, where the Territorial Health Administration (ATS) exercises the powers assigned to regional health agencies. A key challenge is the need to collect health data to identify unusual health events and develop an appropriate response. The objective of this article is to present the surveillance systems established in the territory and their initial results. All general practitioners and emergency physicians at the François Dunan Hospital Center (CHFD) were involved in creating a network of sentinel physicians specifically monitoring six indicators. Concurrently, the CHFD emergency department was integrated into the OSCOUR® network (Organization for Coordinated Emergency Surveillance), and emergency department visit summaries (RPU) have been transmitted to Santé publique France since April 2018. Administrative data on deaths are also integrated into this surveillance system. The sentinel network began operations in week 14 of 2018. The implementation of these systems makes it possible to obtain comprehensive data on consultations regarding the specifically monitored indicators as well as on emergency department visits, and to detect unusual phenomena. Thus, between September 2018 and February 2019, an outbreak of influenza-like illnesses and an outbreak of chickenpox were identified. Analysis of emergency department visits shows that trauma is the leading cause of visits. Young adults (ages 15–54) account for about half of all visits, followed by those under 15 (23% of visits) and the elderly (10%). Annual visit rates were higher than in mainland France for 2017 and 2018 (680 visits per 1,000 inhabitants). Between 2011 and 2019, annual mortality rates ranged from 5.9 deaths per 1,000 inhabitants (in 2012) to 9.7 per 1,000 (in 2017). To complement this system and better understand health behaviors, the development of indicators through the creation of a Public Health France Barometer, initially planned for April 2020, has been postponed by a few weeks due to the COVID-19 pandemic.