The mother of a Southern Highlands girl killed during an elite equestrian event in NSW expressed concerns about the course on the morning of her daughter's death, including about the obstacle her daughter later died jumping.
The inquest has begun into the deaths of two "clever and vibrant" young women who were fatally crushed by their horses during separate riding competitions in 2016.
Olivia Inglis, 17, died on March 6, 2016 after her horse missed his stride and hit a jump two minutes into the cross-country event at the Scone Horse Trials in the Upper Hunter region.
The horse, Coriolanus, fell onto Olivia and left her with major chest injuries.
Her parents, who were at the event, heard there had been a fall and rushed to her side.
She was unable to be revived, despite first aid being administered and paramedics being brought to the scene in a Westpac helicopter.
The inquest heard she was not conscious after the fall and did not suffer.
Her horse was put down after sustaining a fractured neck in the fall.
About seven weeks later, on April 30, 19-year-old Caitlyn Fischer died seconds into her cross-country run at the Sydney International Horse Trials when her horse's front feet hit the second jump.
The horse then fell on her, causing head injuries and killing her instantly.
Caitlyn's mother, a registered nurse who has worked in intensive care, sprinted onto the course and was the first to reach her daughter's side. She was immediately able to see that Caitlyn had passed away.
On Monday, a two-week inquest into the deaths opened at Lidcombe Coroner's Court in Sydney. It will examine nine issues, including whether safety procedures at equestrian events are adequate, and whether physical aspects of the courses contributed to the deaths of Caitlyn and Olivia.
Counsel assisting the inquest, Dr Peggy Dwyer, said there is no doubt the three-pronged sport of eventing - comprising dressage, show jumping and cross-country - is a "challenging and dangerous sport", but one of the aims of the inquest will be to minimise the risk of injury.
Dr Dwyer said there has already been "significant change introduced to the sport in NSW" including the use of collapsible pins in certain jumps, so they effectively fold in and collapse if they are struck by a horse. This reduces the chance for a "rotational fall", the type of fall Caitlyn and Olivia were involved in.
In April 2017, a year after the deaths, Equestrian Australia, the governing body for the sport, also employed a safety officer for the first time.
Dr Dwyer said both Caitlyn and Olivia were "beautiful young women" who were "clever and vibrant". They were highly experienced and competed in eventing at an elite level.
"There is a common thread in relation to both Caitlyn and Olivia that they were both young women with enormous potential, both intellectually, personally, and of course also in this sport," Dr Dwyer said. "Both of them were also delightful young women."
The inquest is expected to hear that Olivia's mother Charlotte Inglis walked the cross-country course with her daughter on the morning of her fall, and had concerns about "a number of jumps" including a combination jump, 8A and 8B, which had a downward approach.
She was so worried she spoke to another rider, Olympic champion Shane Rose. Olivia went ahead with her ride, and died after her horse fell on jump 8B.
Caitlyn's run on the cross-country course was delayed for 10 minutes after another rider fell. Her accident, 210 metres from the start of the course, was captured on video, which will not be made public out of respect for her family.
Deputy State Coroner Derek Lee extended his personal condolences to the girls' families and friends, who were present in court.
"I remain deeply saddened by your tragic losses," Mr Lee said.
In a statement read out to the inquest, Equestrian Australia CEO Lucy Warhurst said the organisation is "deeply sorry for the loss" of the two young women and seeks to provide the safest possible environment for its riders.
"Both Olivia and Caitlyn are sorely missed by the entire equestrian community," Ms Warhurst said.
Change of rules after tragedies
Equestrian Australia has changed rules to improve rider safety as a NSW coroner's inquiry hears evidence from today about the deaths of teenager Olivia Inglis at a Scone riding event in 2016 and Caitlyn Fischer at a Sydney championship less than two months later.
Deputy State Coroner Derek Lee will determine a cause of death for Ms Inglis, 17, who died in a fall at the NSW Eventing Championships on March 6, 2016 while riding her horse partner of four years, Coriolanus.
Ms Inglis died after a fall at the event's eighth jump where the only person at the jump, a fence judge, is expected to give evidence she heard a crash but did not see what happened before the fall.
Ms Inglis' parents Charlotte and Arthur, who were at the event, have previously said their daughter died instantaneously of a ruptured pulmonary artery but have questioned whether the horse fell on the teenager because there was no extensive bruising.
Olivia was one of the youngest members of the NSW eventing squad.
Caitlyn Fischer, 19, died on April 29, 2016 when she was crushed by her horse in a cross-country competition at the Sydney International Horse Trials.
Her horse Ralphie fell when its foot caught on a second fence during the competition.
In the wake of the teenagers' deaths Equestrian Australia commissioned reports from two review panels which recommended a number of changes to improve safety.
Equestrian Australia made frangible pins that allow jumps to collapse mandatory at eventing events.
In a statement after the teenagers' deaths Equestrian Australia said eventing was "without doubt the toughest equestrian discipline on both horse and rider" because it incorporated the three Olympic disciplines of dressage, show jumping and cross country.
Equestrian Australia employed a part-time safety officer for three years using part of a $250,000 donation from equestrian centre owner Terry Snow.
In the past few months Equestrian Australia has announced rule changes requiring riders to wear body protectors in the cross country phase of eventing, and mandatory helmet compliance testing.
The inquest into Ms Inglis' and Ms Fischer's deaths is expected to hear evidence all week.