Eric J. Lyman

USA TODAY

AMATRICE, Italy — Work crews digging through rubble in quake-ravaged mountainous towns in central Italy found more bodies Thursday, bringing the death toll to at least 267. But they also found rare moments of joy when their frenzied, round-the-clock excavation freed survivors still trapped for more than a day beneath tons of rock and metal.

“We just pulled a woman from the rubble," said Claudio Catanese, 32, a fireman and volunteer rescuer working in the hard hit town of Amatrice. "She was in good health, feeling fine, and just thirsty and hungry after 36 hours under rocks and dust. The first thing she did was ask for a glass of water."

He said the work, nonstop, is hard, but critical. "You don’t sleep and your muscles hurt," Catanese said. "But when you save someone’s life, it fills you with new energy. There’s a great satisfaction in that."

In Pescara del Tronto, firefighters plucked an 10-year-old girl named Giorgia from the rubble where she had been trapped for 16 hours. Rescuers said they were able to locate the area of Giorgia's room and started digging until they reached her. They also found the body of her sister, who was lying next to her, Italian news agency ANSA reported.

Italy’s civil protection agency said early Thursday that at least 250 people were killed and at least 365 others hospitalized. A Spaniard and five Romanians were among the dead, according to their governments. If the death toll tops 300 it will be the deadliest earthquake in modern Italian history, surpassing the total from the 2009 quake in L’Aquilla.

Most of the victims — 184 — were found in Amatrice, a picturesque medieval town of around 3,000 people.

The 6.2-magnitude quake struck at 3:30 a.m. Wednesday, sending tons of stone walls on many victims while they were sleeping. But rescue workers and civil protection officials said the death toll would have been worse if it hit during the day when many of the public buildings destroyed were occupied.

In Amatrice, some people whose houses were built on a slant were especially lucky. They awoke from their sleep unscathed to find the outside wall of their building collapsed outward.

"They've told us for years we should make our houses anti-seismic," said Gloria Nardo, 69, of Amatrice. "But how do you retrofit a brick house built in 1750? It's almost all gone now."

The search efforts are focused around the isolated hilltop communities of Amatrice, Accumoli and Pescara del Tronto where sniffer dogs, firefighters and paramedics were desperately searching for signs of life amid huge chunks of rock, cement and metal from collapsed homes and buildings.

Thousands of rescuers are using heavy lifting equipment to sift through the rubble but many are also using their bare hands.

At least one major bridge leading to Amatrice was compromised by the temblor and unable to support the weight of the heavy equipment needed to move big pieces of rock or walls. But volunteers were able to reinforce the bridge enough for the equipment to move within about 12 hours of the quake.

One rescue operation was mounted at the Hotel Roma in Amatrice, where an annual spaghetti festival was scheduled this weekend to honor the town's signature bacon and tomato pasta sauce.

Amatrice’s mayor initially said 70 guests were in the collapsed hotel, but rescue workers later cut the estimate in half after the owner said most guests had managed to escape.

Firefighters’ spokesman Luca Cari said one body had been pulled out of the hotel just before dawn after five others were extracted earlier but searches continued there and elsewhere.

Meanwhile, a prosecutor in Rieti opened an investigation into possible culpable negligence over the collapse of two recently restored structures — a school in Amatrice and a bell tower in Accumoli, RAI-TV reported.

Italy's Prime Minister Matteo Renzi visited the quake-affected area Wednesday. He vowed to rebuild “and guarantee a reconstruction that will allow residents to live in these communities, to relaunch these beautiful towns that have a wonderful past that will never end.”

Italy's civil protection agency said the first estimate for damage is about $11 billion. The nation’s culture ministry decreed that proceeds from public museums across Italy on Sunday will be dedicated to helping restore damaged buildings in the quake zone, the Associated Press reported. Several churches and other medieval-era buildings were damaged or destroyed.

In a statement Thursday, Culture Minister Dario Franceschini urged Italians to go out in force Sunday to visit museums and Italy’s numerous archaeological sites “in a concrete sign of solidarity” with quake victims.

Town leveled by earthquake was voted one of Italy's most beautiful