An aerial view shows the damage in Amatrice. Photo: AP
Another hard-hit town was Pescara del Tronto, where the main road was covered in debris and residents were excavating their neighbours out by hand as emergency crews had yet to arrive.
Photos taken from the air by regional firefighters presented the town basically flattened; Italy requested EU satellite images of the whole area to assess the scale of the damage.
Tourists on holiday in the region told the Guardian of their experiences. The earthquake and at least one aftershock caused us to run out of the buildings in a panic, said Nick Mortimer, one of a family of nine meet for a 60 th birthday gala in nearby Amandola.
Renata Morioni, on holiday a few miles from Amatrice, said: I felt a very strong shaking at about 3am It went on for ages then again about half an hour or 45 minutes later. Terrifying.
Dr Mark Quigley, an active tectonics and geomorphology prof at the University of Melbourne, said about 13,000 people would have experienced severe ground shaking persisting for probably 10 to 20 seconds, and another 230,000 would have felt very strong tremors.
This earthquake is no surprise, said Quigley. This is one of the most seismically active parts of Italy. He noted that six severe earthquakes had hit individual regions in the past seven centuries, including a series of three magnitude-6 quakes in 1703 that killed an estimated 10,000 people. Italys deadliest earthquake in the 20 th century came in 1908, when a major tremor followed by a tsunami left an estimated 80,000 people dead in the southern regions of Reggio Calabria and Sicily.
As residents, civil protection workers and even priests dug through the rubble, calls went out for more equipment and helpers.
We need chainsaws, shears to cut iron bars, and jacks to remove beams: everything, we need everything, Andrea Gentili, a civil protection employee, said. The national blood service appealed for donations to Rietis hospital.
I dont know what to say. We are living this immense misfortune, said the Rev Savino DAmelio, a parish clergyman. We are only hoping there will be the least number of victims possible and that we all have the gallantry to move on.
Pirozzi, the mayor, said poor access to the village was hampering operations. There is a landslide on one road, a bridge is about to collapse on the other one, he said.
The 2009 Aquila quake led to lengthy recriminations over lax build controls and the failure of authorities to warn residents a quake could be imminent. Volunteers from Aquila were among those who constructed their way to Amatrice on Wednesday to help however they could.
Standing by the roadside just outside the town waiting to be allowed in as survivors filed slowly past, some carrying plastic bags stuffed with belongings, others with their limbs in slings, was Ludovica Baschinna, 18.
I felt it at 3.30, felt the house shaking, she said. I was very afraid that it was happening all over again in Aquila. I lived through that earthquake in 2009 and I know what it would seem to be. So I thought it was just my responsibility today to come here and help out, to give a hand.
Stefano Prentera, a doctor, had come from Rome to help, setting up a small makeshift clinic on the edge of town. He said he had been working all day and had treated about 30 patients for minor and more serious injuries. Its a very dramatic situation, he said. A very difficult time for everyone.