A NSW coroner has called for better safety measures after a world champion water skier died during a high-speed river race.
Sarah Teelow, 20, was critically injured during the 112-kilometre Bridge to Bridge Water Ski Classic on the Hawkesbury River in November 2013.
Acting State Coroner Teresa O'Sullivan recommended improvements to helmet and flotation device specifications and the consideration of speed restrictions while delivering her findings at Glebe Coroners Court on Thursday.
"Further safety improvements could be made to the sport," Ms O'Sullivan said.
The young woman from Wellington, near Dubbo in the state's central west, suffered serious head injuries when she crashed in the opening moments of the event on November 24.
She was airlifted to the Royal North Shore Hospital but died a day later with her parents at her bedside.
The coroner recommended that Ski Racing Australia consider developing helmet and personal flotation device technical specifications and speed restrictions in the Formula Two class.
Ski Racing Australia should also consider introducing a rule requiring race scrutineers to ensure competitor helmets worn are secure.
And the Roads and Maritime Services should explore whether a speed restriction should be a condition of an aquatic licence for the event, the coroner said.
The Women's World Formula Two champion fell off her ski after she hit the wake created by another boat while travelling at up to 136km/h.
Ms Teelow's mother, Tania, who is also a champion water skier, said outside court the recommendations don't go far enough and she's worried more people could die if strong changes aren't made.
According to the University of Technology Sydney website, Ms Teelow, a bachelor of human movement student, was part of an elite athlete scholarship program.