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1 Do it immediately at the start of the game, before even capping Triads.
2 Make sure to memorize all shortcuts, either in grassy areas, or inbetween buildings. You will never beat it if you follow the road readily available on the minimap.
3 Get acquainted with driving and evading other vehicles. Use the camera angle that helps you best.
4 This specific mission, involves lots of luck. Like the placement of patients on the map and the distance between them. The places that they spawn at. Trickiest spawns are inside the ♥♥♥♥♥♥♥ Dog Food restaurant and in the sports field with fence all around.
5 Last but not least, you have to strategize and prioritize your pickups, leaving those closest to the hospital for last. This is hard to do, especially with lack of a map, like Vice City's or San andreas'.
It took me consequtive tries, for 2 days straight i had been struggling. There are even accidents that can happen, like a patient run over by another car, your ambulance suddenly flipping, or catching fire from damage. Other people suggest using the siren, others advice against that. I found that siren off worked best for me, because cars act unreliably and in panic (like completely stopping and blocking your road, or when they go over one side then suddenly go over the opposite one while you try to bypass it).
Good luck! That is the most you 're going to need, at the end of the day!
Best of luck (in fact, hope you've done it by now)!
I can reliably get up to level 8 and then the ambulance flips after I hit a curb :(.
As for me, I tried to complete this missions without sirens many times, but the cars kept bumping into me and blocking the road. With the sirens turned on, they will give road, so there's less chance to bump into them and lose time.
Still, everyone has their way.