I have finished this game 5 times already on Survival difficulty. I took me 5.5 hours in my first playthrough. My most recent is under 2 hours (1:59:56), 120% score.

Understand the game mechanics and be patient. Gaming instincts also applies here. Get a grip on these and you will swear this game is quite easy. Don't worry having no bullets at all. The game will provide the least amount of bullets required to survive a combat. I find myself magically produce 1 bullet before a fight whenever I have zero ammo. You might not be able to rescue victims though, you should save bullets whenever you can.

Don't be stingy on using items (especially soda cans, fruit cocktails, pitons, painkillers and adrenaline syringes). Use if needed. If you have more than 2 of that item then it's safe to consume one for your needs.

Always take out guys with guns first and grab their guns immediately. If outnumbered, take out the leader first. Others will surrender if the leader is taken out. Listen to their voices to identify the leader. The leader is always either a buff bandana dude or a big healthy negro.

If this doesn't float your boat then you better be sailing on other waters. This game ain't for you.