In its Judgment in San Lorenzo and Croce Verde Cogema, C-113/13 (only press release available for now), the CJEU seems to have ruled that emergency ambulance services "may be entrusted on a preferential basis and by direct award to voluntary associations. In order to do so, the system must actually contribute to the pursuit of the objectives of the good of the community and budgetary efficiency".
Without knowing the details of the full Judgment, it is hard to see the exact space for such direct award and all the caveats implicit in it. However, as a first reaction, it seems clear that this adds yet another layer of complication to the procurement regime applicable to ambulance services under the EU public procurement rules. Recital (28), art 74 and annex XIV of Directive 2014/24 will need to be reconciled with the Judgment in San Lorenzo and Croce Verde Cogema, which may result in some legal uncertainty as to whether direct award is really possible or the simplified regime in art 74 (or even art 77) trump the position of the CJEU.
I will look at this in detail once the full Judgment is available, but the application of EU procurement rules to ambulance services seems to be unnecessarily complicated.