A Quebec coroner is asking provincial and federal ski bodies to review their training and safety practices after a six-year-old girl died when she was dragged by a T-bar lift during a ski lesson in January.
Coroner Julie-Kim Godin released her report this month into the Jan. 29 death of Lily Leblanc at the Val-St-Côme ski resort in Quebec’s Lanaudière region.
The report says the girl was on the T-bar with another student when her instructor, who was riding another bar behind her, asked them to get off because another student had fallen.
Leblanc tried to get off but fell, and the hood of her coat got caught in the T-bar, resulting in her being dragged 540 metres and asphyxiated.
While the death was deemed accidental, Ms. Godin’s recommendations raised questions about the safety practices in place for teaching and supervising skiers.
“The basic safety rules and written directives regarding emergency measures for all foreseeable situations at the Val St-Côme station were ignored,” reads Ms. Godin’s report, dated Nov. 13. “We can even wonder if they had been taught to the attendants.”
Ms. Godin found that several factors contributed to the death, including that the child wasn’t riding with an adult and was told to get off the moving lift, likely because the instructor had been taught to keep their group together at all times.
The report also found the instructor and the employees operating the lift failed to follow basic safety principles by restarting the T-bar—after initially stopping it—without checking to make sure the young girl was safe.
“Nobody went to help Lily or check that she’d gotten up before putting the lift back into function, and this, when it was known she’d fallen and was hanging from a T-bar that was stuck in a part of her coat,” the report says.
In the moments after the fall, the instructor took the remaining two students to the bottom, and asked the lift operator to stop the lift because a student was stuck. However, the decision was made moments later to restart it, despite nobody having made visual contact with Leblanc, the report says.
The lift operator at the top of the hill eventually saw the young girl being pulled up by the T-bar, unconscious. Because the radio to reach the ski patrol wasn’t working, the employee went down on foot to find help. Leblanc was taken to a nurse’s station and then to hospital, where she was declared dead several hours later.
The coroner concluded that the instructor, who was supervising three students, was faced with a difficult situation when the first student fell: either order the other two students off the moving lift, or allow the group to be separated, both of which go against safety rules.
“This is an exceptional situation where it was necessary to prioritize one of the two principles,” she wrote. “The decision that was made triggered the cascade of events that followed.”
However, she noted the problem could have been avoided had all the children been travelling with an instructor or adult. She also said the lift operators reported having received only four hours of training, and didn’t recall having been given “any specific procedure” to follow in case of a fall.
The coroner recommended the Canadian Standards Association and Quebec’s ski resorts association “look into the events surrounding Lily’s death in order to review the supervision of the training of operators and attendants and to put in place solutions to prevent a similar event and avoidable deaths.”
She also called on the Canadian and provincial ski and snowboard instructor associations to improve training and urged Quebec’s ski resorts association and Val St-Côme to look at ways of having more staff in place during children’s lessons.
The report notes that the Val St-Côme ski resort has since replaced its T-bar with a “magic carpet”-style lift and confirmed that students will be accompanied by an instructor when riding up the mountain.
The ski resorts association said in a news release that it is forming an experts committee to review the existing guide for ski schools and will offer new training for ski lift monitors as of December.
