This presentation reviews the process of designing and building a T4 model using inexpensive materials and spare parts from the Simulation Center, specifically a discarded plastic mannequin torso, a slab of pig ribs and pig skin. The T4 model allows a learner to palpate intercostal spaces through skin, prep and drape skin, make an incision, palpate the moving lung, insert a chest tube, and suture the tube in place. Compared to commercial products, use of the trainer provided a total cost savings per ATLS Course of $4,946.